Nau Ob Test 1-3

When caring for pregnant women, the nurse should keep in mind that violence during pregnancy:
A) Affects more than 25% of pregnant women in the United States.
B) Is associated with complications of pregnancy such as bleeding.
C) Increases a pregnant woman's risk for preeclampsia.
D) Has decreased in incidence as a result of better assessment techniques and record keeping.

B) Is associated with complications of pregnancy such as bleeding.
Feedback: Approximately 8% of pregnant women are battered; the incidence of battering increases during pregnancy. Violence is associated with complications of pregnancy such as bleeding. Violence itself has no correlation to the incidence of preeclampsia. The rates of violence have increased, possibly because of better assessment and reporting mechanisms.

The family structure consisting of parents and their dependent children living together is known as a(n):
A) Binuclear family.
B) Reconstituted family.
C) Nuclear family.
D) Extended family.

C) Nuclear family.
Feedback: Binuclear refers to the family after divorce. Reconstituted includes stepparents and stepchildren. Nuclear family includes parents and children (natural or adopted) who live in a common household. Extended family includes the nuclear family and other people related by blood.

A woman is giving birth to her third child in a setting that allows her husband and other two children to be actively involved in the process. The nurse caring for the woman must also consider the husband and family as patients and work to meet their needs. This type of setting is termed:
A) Family-centered care.
B) Emergency care.
C) Hospice care.
D) Individual care.

A) Family-centered care.
Feedback: Family-centered care is any setting in which the pregnant woman and family are treated as one unit. The nurse assumes a major role in teaching, counseling, and supporting the family. In emergency care settings the nurse deals primarily with the patient who is having difficulty. In hospice care settings the nurse deals with patients who have terminal illnesses. Individual care deals only with the patient and does not include the family.

A) Diabetes mellitus.
Feedback: The most frequently reported maternal medical risk factors are diabetes and hypertension associated with pregnancy. Both of these conditions are associated with maternal obesity. There are no studies that indicate MVP is among the most frequently reported maternal risk factors. Hypertension associated with pregnancy is one of the most frequently reported maternal medical risk factors, not chronic hypertension. Although anemia is a concern in pregnancy, it is not one of the most frequently reported maternal medical risk factors in pregnancy.

While working in the prenatal clinic, you care for a very diverse group of clients. When planning interventions for these families, you realize that acceptance of the interventions will be most influenced by:
A) Educational achievement.
B) Income level.
C) Subcultural group.
D) Individual beliefs.

D) Individual beliefs.
Feedback: The client's beliefs are ultimately the key to acceptance of health care interventions. However, these beliefs may be influenced by factors such as educational level, income level, and ethnic background. Educational achievement, income level, and subcultural group are all important factors. However, the nurse must understand that a woman's concerns from her own point of view will have the most influence on her compliance.

The woman's family members are present when the nurse arrives for a postpartum and newborn visit. What should the nurse do?
A) Observe the family members’ interactions with the newborn and one another.
B) Ask the woman to meet with her and the baby alone.
C) Do a brief assessment on all family members present.
D) Reschedule the visit for another time so that the mother and infant can be assessed privately.

A) Observe the family members’ interactions with the newborn and one another.
Feedback: The nurse should introduce herself to the client and the other family members present. Family members in the home may be providing care and assistance to the mother and infant. However, this care may not be based on sound health practices. Nurses should take the opportunity to dispel myths while family members are present. The responsibility of the home care maternal-child nurse is to provide care to the new postpartum mother and her infant, not to all family members. The nurse can politely ask about the other people in the home and their relationships with the woman. Unless an indication is given that the woman would prefer privacy, the visit may continue.

The client's family is important to the maternity nurse because:
A) They pay the bills.
B) The nurse will know which family member to avoid.
C) The nurse will know which mothers will really care for their children.
D) The family culture and structure will influence nursing care decisions.

D) The family culture and structure will influence nursing care decisions.
Feedback: Family structure and culture influence the health decisions of mothers.

Which statement about family systems theory is NOT accurate?
A) A family system is part of a larger suprasystem.
B) A family as a whole is equal to the sum of the individual members.
C) A change in one family member affects all family members.
D) The family is able to create a balance between change and stability.

B) A family as a whole is equal to the sum of the individual members.
Feedback: A family as a whole is greater than the sum of its parts. The other statements are characteristics of a system that states that a family is greater than the sum of its parts.

The process by which people retain some of their own culture while adopting the practices of the dominant society is known as:
A) Acculturation.
B) Assimilation.
C) Ethnocentrism.
D) Cultural relativism.

A) Acculturation.
Feedback: Acculturation is the process by which people retain some of their own culture while adopting the practices of the dominant society. This process takes place over the course of generations. Assimilation is a loss of cultural identity. Acculturation describes the process by which people retain some of their own culture while adopting the practices of the dominant society. Ethnocentrism is the belief in the superiority of one's own culture over the cultures of others. Acculturation describes the process by which people retain some of their own culture while adopting the practices of the dominant society. Cultural relativism recognizes the roles of different cultures. Acculturation describes the process by which people retain some of their own culture while adopting the practices of the dominant society.

What are the primary goals of the assessment phase of a perinatal home visit?
A) Creating a meal and exercise plan for the pregnant woman.
B) Identifying a network of supportive individuals.
C) Developing a trusting relationship and collecting data.
D) Initiating a prenatal appointment schedule and birth plan.

C) Developing a trusting relationship and collecting data.
Feedback: Creating a meal and exercise plan would be developed after the data collection if the woman is in need of better nutritional guidelines. Identifying a network of supportive individuals who will help with the new baby and/or other family members is important but not a goal of assessment. The primary goals of the initial visit in a perinatal home visit are to develop a trusting relationship to ensure that the pregnant woman will be honest about her care and to collect initial data to develop diagnosis, interventions, and outcomes to maintain the health of the fetus and mother. The prenatal schedule of appointments and a birthing plan would be established during the planning phase, not during the assessment phase.

A) Immunizations
Feedback: Primary prevention involves health promotion and disease prevention activities to reduce the occurrence of illness and enhance general health and quality of life. This includes immunizations, using infant car seats, and health education to prevent tobacco use. Breast self-examination is an example of secondary prevention, which involves early detection of health problems. Home care for a high risk pregnancy is an example of tertiary prevention. This level of care follows the occurrence of a defect or disability. Blood pressure screening is an example of secondary prevention. It is a screening tool for early detection of a health care problem.

During an in-home visit, the nurse appropriately may:
A) Smoke if the expectant mother smokes.
B) Ask to have the volume on the TV turned down or move to a quiet room.
C) Give ample advice and reassurance to establish authority.
D) Freely move whatever furniture and belongings the nurse feels necessary.

B) Ask to have the volume on the TV turned down or move to a quiet room.
Feedback: The nurse must respect the client's home but must also find a place to talk that is free of distractions. Modeling healthy behavior such as not smoking without being preachy is an important responsibility of the nurse. Giving too much advice and false assurances creates barriers to communication. The nurse should always ask permission to move things and should take care to avoid moving personal belongings not affected by care.

One purpose of preconception care is to:
A) Ensure that pregnancy complications do not occur.
B) Identify women who should not become pregnant.
C) Encourage healthy lifestyles for families desiring pregnancy.
D) Ensure that women know about prenatal care.

C) Encourage healthy lifestyles for families desiring pregnancy.
Feedback: Preconception counseling guides couples in how to avoid unintended pregnancies, how to identify and manage risk factors in their lives and their environment, and how to identify healthy behaviors that promote the well-being of the woman and her potential fetus. Preconception care does not ensure that pregnancy complications will not occur. In many cases problems can be identified and treated and may not recur in subsequent pregnancies. In many instances counseling can allow behavior modification before damage is done, or a woman can make an informed decision about her willingness to accept potential hazards. If a woman is seeking preconception care, she likely is aware of prenatal care.

The nurse who provides preconception care understands that it:
A) Is designed for women who have never been pregnant.
B) Includes risk factor assessments for potential medical and psychologic problems but by law cannot consider finances or workplace conditions.
C) Avoids teaching about safe sex to avoid political controversy.
D) Could include interventions to reduce substance use and abuse.

D) Could include interventions to reduce substance use and abuse.
Feedback: If assessments indicate a drug problem, treatment can be suggested or arranged. Preconception care is designed for all women of childbearing potential. Risk factor assessment includes financial resources and environmental conditions at home and work. Health promotion can include teaching about safe sex.

Concerning the use and abuse of legal drugs or substances, nurses should be aware that:
A) Although cigarette smoking causes a number of health problems, it has little direct effect on maternity-related health.
B) Women ages 21 to 34 have the highest rates of specific alcohol-related problems.
C) Coffee is a stimulant that can interrupt body functions and has been related to birth defects.
D) Prescription psychotherapeutic drugs taken by the mother do not affect the fetus; otherwise they would not have been prescribed.

B) Women ages 21 to 34 have the highest rates of specific alcohol-related problems.
Feedback: Although a very small percentage of childbearing women have alcohol-related problems, alcohol abuse during pregnancy has been associated with a number of negative outcomes. Cigarette smoking impairs fertility and is a cause of low birth weight. Caffeine consumption has not been related to birth defects. Psychotherapeutic drugs have some effect on the fetus, and that risk must be weighed against their benefit to the mother.

The use of methamphetamine (meth) has been described as the number one drug problem in America. To provide adequate nursing care to this client population the nurse must be cognizant that methamphetamine:
A) Is used only by those of a higher socioeconomic status because of the expense.
B) Uses amphetamine, a central nervous system stimulant, as the active ingredient.
C) Manifests a response similar to marijuana when smoked.
D) Decreases sexual activity when used among fertile women.

B) Uses amphetamine, a central nervous system stimulant, as the active ingredient.
Feedback: The use of meth procures a long-lasting high, manifested by hyperactivity, euphoria, increased vital signs, and potentially violent behavior. Meth is relatively cheap and is "hooking" more people across the socioeconomic spectrum. When smoked, the behavior of the client is similar to that resulting from use of cocaine, not similar to marijuana use. Meth results in users feeling hypersexual and uninhibited, leading to unsafe sexual practices.

As a powerful central nervous system stimulant, which of these substances can lead to miscarriage, preterm labor, premature separation of the placenta, and stillbirth?
A) Heroin
B) Alcohol
C) PCP
D) Cocaine

D) Cocaine
Feedback: Cocaine is a powerful central nervous system stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth. Heroin is an opiate. Its use in pregnancy is associated with preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. The most serious effect of alcohol use in pregnancy is fetal alcohol syndrome. The major concerns regarding PCP use in pregnant women are its association with polydrug abuse and the neurobehavioral effects on the neonate.

Kegel exercises, or pelvic muscle exercises:
A) Were developed to control or reduce incontinent urine loss.
B) Are the best exercises for a pregnant woman because they are so pleasurable?
C) Help to manage stress.
D) Are ineffective without sufficient calcium in the diet.

A) Were developed to control or reduce incontinent urine loss.
Feedback: Kegel exercises help control the urge to urinate. They may be fun for some, but the most important matter is the control they provide over incontinence. Kegel exercises help manage urination, not stress. Calcium in the diet is important, but is not related to Kegel exercises.

D) Ovulation and hormone production.
Feedback: The two functions of the ovaries are ovulation and hormone production. The presence of ovaries does not guarantee normal female development. The ovaries produce estrogen, progesterone, and androgen. Ovulation is the release of a mature ovum from the ovary; the ovaries are not responsible for interval pelvic support. Sexual response is a feedback mechanism involving the hypothalamus, anterior pituitary gland, and the ovaries. Ovulation does occur in the ovaries.

A) Cyclic menstruation.
Feedback: The uterus is an organ for reception, implantation, retention, and nutrition of the fertilized ovum; it also is responsible for cyclic menstruation. Hormone production and fertilization occur in the ovaries. Sexual arousal is a feedback mechanism involving the hypothalamus, the pituitary gland, and the ovaries.

D) Progesterone.
Feedback: Progesterone causes maturation of the mammary gland tissue, specifically acinar structures of the lobules. Estrogen increases the vascularity of the breast tissue.
Testosterone has no bearing on breast development. Prolactin is produced after birth and released from the pituitary gland. It is produced in response to infant suckling and emptying of the breasts.

Because of the effect of cyclic ovarian changes on the breast, the best time for breast self-examination (BSE) is:
A) Five to 7 days after menses ceases.
B) Day 1 of the endometrial cycle.
C) Midmenstrual cycle.
D) Any time during a shower or bath.

A) Five to 7 days after menses ceases.
Feedback: The physiologic alterations in breast size and activity reach their minimal level about 5 to 7 days after menstruation stops. Therefore, all women should perform BSE during this phase of the menstrual cycle.

The transition phase during which ovarian function and hormone production decline is called:
A) The climacteric.
B) Menarche.
C) Menopause.
D) Puberty.

A) The climacteric.
Feedback: The climacteric is a transitional phase during which ovarian function and hormone production decline. Menarche is the term that denotes the first menstruation. Menopause refers only to the last menstrual period. Puberty is a broad term that denotes the entire transitional stage between childhood and sexual maturity.

Which statement would indicate that the client requires additional instruction about breast self-examination?
A) “Yellow discharge from my nipple is normal if I’m having my period.”
B) “I should check my breasts at the same time each month, like after my period.”
C) “I should also feel in my armpit area while performing my breast examination.”
D) “I should check each breast in a set way, such as in a circular motion.”

A) “Yellow discharge from my nipple is normal if I’m having my period.”
Feedback: Discharge from the nipples requires further examination from a health care provider. "I should check my breasts at the same time each month, like after my period," "I should also feel in my armpit area while performing my breast examination," and "I should check each breast in a set way, such as in a circular motion" all indicate successful learning.

A) Uterus.
Feedback: The uterus is responsible for cyclic menstruation. It also houses and nourishes the fertilized ovum and the fetus. The ovaries are responsible for ovulation and production of estrogen; the uterus is responsible for cyclic menstruation. The vaginal vestibule is an external organ that has openings to the urethra and vagina; the uterus is responsible for cyclic menstruation. The urethra is not a reproductive organ, although it is found in the area; the uterus is responsible for cyclic menstruation.

When assessing the client for amenorrhea, the nurse should be aware that this may be caused by all conditions except:
A) Anatomic abnormalities.
B) Type 1 diabetes mellitus.
C) Lack of exercise.
D) Hysterectomy.

C) Lack of exercise.
Feedback: Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea. Anatomic abnormalities, type 1 diabetes mellitus, and hysterectomy are all possible causes of amenorrhea.

When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?
A) Increasing the intake of red meat and simple carbohydrates
B) Reducing the intake of diuretic foods such as peaches and asparagus
C) Temporarily substituting physical activity for a sedentary lifestyle
D) Using a heating pad on the abdomen to relieve cramping

D) Using a heating pad on the abdomen to relieve cramping
Feedback: Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as eating less red meat may be recommended for women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon, may help ease the symptoms associated with dysmenorrhea. Exercise has been found to help relieve menstrual discomfort through increased vasodilation and subsequent decreased ischemia.

A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:
A) Endometriosis.
B) PMS.
C) Primary dysmenorrhea.
D) Secondary dysmenorrhea.

A) Endometriosis.
Feedback: Symptoms of endometriosis can change over time and may not reflect the extent of the disease. Major symptoms include dysmenorrhea and deep pelvic dyspareunia (painful intercourse). Impaired fertility may result from adhesions caused by endometriosis.
Although endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility, which are associated with endometriosis, not with PMS or primary or secondary dysmenorrhea.

While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client's recent menstrual cycles. The nurse should collect additional information with which statement?
A) The woman says her menstrual flow lasts 5 to 6 days.
B) She describes her flow as very heavy.
C) She reports that she has had a small amount of spotting midway between her periods for the past 2 months.
D) She says the length of her menstrual cycle varies from 26 to 29 days.

B) She describes her flow as very heavy.
Feedback: Menorrhagia is defined as excessive menstrual bleeding, in either duration or amount. Heavy bleeding can have many causes. The amount of bleeding and its effect on daily activities should be evaluated. A menstrual flow lasting 5 to 6 days is a normal finding. Mittlestaining, a small amount of bleeding or spotting that occurs at the time of ovulation (14 days before onset of the next menses), is considered normal. During her reproductive years, a woman may have physiologic variations in her menstrual cycle. Variations in the length of a menstrual cycle are considered normal.

With regard to endometriosis, nurses should be aware that:
A) It is characterized by the presence and growth of endometrial tissue inside the uterus.
B) It is found more often in African-American women than in Caucasian or Asian women.
C) It may worsen with repeated cycles or remain asymptomatic and disappear after menopause.
D) It is unlikely to affect sexual intercourse or fertility.

C) It may worsen with repeated cycles or remain asymptomatic and disappear after menopause.
Feedback: Symptoms vary among women, ranging from nonexistent to incapacitating. With endometriosis the endometrial tissue is outside the uterus. Symptoms vary among women, ranging from nonexistent to incapacitating. Endometriosis is found equally in Caucasian and African-American women and is slightly more prevalent in Asian women. Women can experience painful intercourse and impaired fertility.

The two primary areas of risk for sexually transmitted infections (STIs) are:
A) Sexual orientation and socioeconomic status.
B) Age and educational level.
C) Large number of sexual partners and race.
D) Risky sexual behaviors and inadequate preventive health behaviors.

D) Risky sexual behaviors and inadequate preventive health behaviors.
Feedback: Risky sexual behaviors and inadequate preventive health behaviors put a person at risk for acquiring or transmitting an STI. Although low socioeconomic status may be a factor in avoiding purchasing barrier protection, sexual orientation does not put one at higher risk. Younger individuals with less education may not be aware of proper prevention techniques: however, these are not the primary areas of risk for STIs. Having a large number of sexual partners is certainly a risk-taking behavior, but race does not increase the risk for STIs.

B) Human papillomavirus (HPV).
Feedback: HPV infection, an STI, is the most prevalent viral STI seen in ambulatory health care settings. HSV-2, HIV, and CMV are all viral STIs, butare not the most prevalent viral STI.

A woman has a thick, white, lumpy, cottage cheese–like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner would order which preparation for treatment?
A) Fluconazole
B) Tetracycline
C) Clindamycin
D) Acyclovir

A) Fluconazole
Feedback: Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat candidiasis. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle?
A) Hysterosalpingogram
B) Endometrial biopsy
C) Laparoscopy
D) Follicle-stimulating hormone (FSH) level

B) Endometrial biopsy
Feedback: Endometrial biopsy is scheduled after ovulation, during the luteal phase of the menstrual cycle. A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing potentially fertilized ovum out through a uterine tube into the peritoneal cavity. Laparoscopy usually is scheduled early in the menstrual cycle. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.

A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. The nurse's most appropriate response is:
A) “Your sperm count seems to be okay in the first semen analysis.”
B) “Only marijuana cigarettes affect sperm count.”
C) “Smoking can give you lung cancer, even though it has no effect on sperm.”
D) “Smoking can reduce the quality of your sperm.”

D) “Smoking can reduce the quality of your sperm.”
Feedback: Use of tobacco, alcohol, and marijuana may affect sperm counts. "Your sperm count seems to be okay in the first semen analysis" is inaccurate. Sperm counts vary from day to day and depend on emotional and physical status and sexual activity. Therefore a single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility. Use of tobacco, alcohol, and marijuana may affect sperm counts.

In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. The husband asks the nurse to explain what the procedure entails. The nurse's most appropriate response is:
A) “IVF is a type of assisted reproductive therapy that involves collecting eggs from your wife’s ovaries, fertilizing them in the lab with your sperm, and transferring the embryo to her uterus.”
B) “A donor embryo will be transferred into your wife’s uterus.”
C) “Donor sperm will be used to inseminate your wife.”
D) “Don’t worry about the technical stuff; that’s what we are here for.”

A) “IVF is a type of assisted reproductive therapy that involves collecting eggs from your wife’s ovaries, fertilizing them in the lab with your sperm, and transferring the embryo to her uterus.”
Feedback: A woman's eggs are collected from her ovaries, fertilized in the laboratory with sperm, and transferred to her uterus after normal embryonic development has occurred. The statement, "A donor embryo will be transferred into your wife's uterus" describes therapeutic donor insemination. "Donor sperm will be used to inseminate your wife" describes the procedure for a donor embryo. "Don't worry about the technical stuff; that's what we are here for" discredits the client's need for teaching and is not the most appropriate response.

Nurses should be aware that infertility:
A) Is perceived differently by women and men?
B) Has a relatively stable prevalence among the overall population and throughout a women’s potential reproductive years.
C) Is more likely the result of a physical flaw in the woman than in her male partner?
D) Is the same thing as sterility?

A) Is perceived differently by women and men?
Feedback: Women tend to be more stressed about infertility tests and to place more importance on having children. The prevalence of infertility is stable among the overall population, but it increases with a woman's age, especially over age 40. Of cases with an identifiable cause, about 40% are related to female factors, 40% to male factors, and 20% to both partners. Sterility is the inability to conceive. Infertility is a state of requiring a prolonged time to conceive, or subfertility.

Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who:
A) Want menstrual regularity and predictability.
B) Have a history of thrombotic problems or breast cancer.
C) Have difficulty remembering to take oral contraceptives daily.
D) Are homeless or mobile and rarely receive health care.

C) Have difficulty remembering to take oral contraceptives daily.
Feedback: Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year. Disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. Use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.

A woman is 16 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is:
A) Dilation and evacuation (D&E).
B) Instillation of hypertonic saline into the uterine cavity.
C) Intravenous administration of Pitocin.
D) Vacuum aspiration.

A) Dilation and evacuation (D&E).
Feedback: The most common technique for medical termination of a pregnancy in the second trimester is D&E. It is usually performed between 13 and 16 weeks. Hypertonic solutions injected directly into the uterus account for less than 1% of all abortions because other methods are safer and easier to use. Intravenous administration of Pitocin is used to induce labor in a woman with a third-trimester fetal demise. Vacuum aspiration is used for abortions in the first trimester.

A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has PKU. The couple tells the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby won't be affected. What response by the nurse is most accurate?
A) "Good planning; you need to take advantage of the odds in your favor."
B) "I think you'd better check with your doctor first."
C) "You are both carriers, so each baby has a 25% chance of being affected."
D) "The ultrasound indicates a boy, and boys are not affected by PKU."

C) "You are both carriers, so each baby has a 25% chance of being affected."
Feedback: The chance is one in four that each child produced by this couple will be affected by PKU disorder. This couple still has an increased likelihood of having a child with PKU. Having one child already with PKU does not guarantee that they will not have another. These parents need to discuss their options with their physician. However, an opportune time has presented itself for the couple to receive correct teaching about inherited genetic risks. No correlation exists between gender and inheritance of the disorder, because PKU is an autosomal recessive disorder.

B) Denial of insurance benefits.
Feedback: Decisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits. Anxiety and altered family relationships, high false positives, and ethnic and socioeconomic disparity are factors that may be difficulties associated with genetic testing, but they are not risks associated with testing.

A man's wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as:
A) Occurrence risk.
B) Recurrence risk.
C) Predictive testing.
D) Predisposition testing.

B) Recurrence risk.
Feedback: The couple already has a child with a genetic disease; therefore they will be given a recurrence risk test. If a couple has not yet had children but are known to be at risk for having children with a genetic disease, they are given an occurrence risk test. This couple already has a child with a genetic disorder. Predictive testing is used to clarify the genetic status of an asymptomatic family member. Predisposition testing differs from presymptomatic testing in that a positive result does not indicate 100% risk of a condition developing.

A key finding from the Human Genome Project is:
A) Approximately 20,000 to 25,000 genes make up the genome.
B) All human beings are 80.99% identical at the DNA level.
C) Human genes produce only one protein per gene; other mammals produce three proteins per gene.
D) Single gene testing will become a standardized test for all pregnant clients in the future.

A) Approximately 20,000 to 25,000 genes make up the genome.
Feedback: Approximately 20,000 to 25,000 genes make up the human genome; this is only twice as many as make up the genomes of roundworms and flies. Human beings are 99.9% identical at the DNA level. Most human genes produce at least three proteins. Single gene testing (e.g., alpha-fetoprotein) is already standardized for prenatal care.

With regard to chromosome abnormalities, nurses should be aware that:
A) They occur in approximately 10% of newborns.
B) Abnormalities of number are the leading cause of pregnancy loss.
C) Down syndrome is a result of an abnormal chromosome structure.
D) Unbalanced translocation results in a mild abnormality that the child will outgrow.

B) Abnormalities of number are the leading cause of pregnancy loss.
Feedback: Aneuploidy is an abnormality of number that also is the leading genetic cause of mental retardation. Chromosome abnormalities occur in fewer than 1% of newborns. Down syndrome is the most common form of trisomal abnormality, an abnormality of chromosome number (47 chromosomes). Unbalanced translocation is an abnormality of chromosome structure that often has serious clinical effects.

A pregnant woman at 25 weeks' gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate?
A) “That must have been a coincidence; babies can’t respond like that.”
B) “The fetus is demonstrating the aural reflex.”
C) “Babies respond to sound starting at about 24 weeks of gestation.”
D) “Let me know if it happens again; we need to report that to your midwife.”

C) “Babies respond to sound starting at about 24 weeks of gestation.”
Feedback: "Babies respond to sound starting at about 24 weeks of gestation" is an accurate statement. "That must have been a coincidence; babies can't respond like that" is inaccurate. Fetuses respond to sound by 24 weeks. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The statement, "Let me know if it happens again; we need to report that to your midwife" is not appropriate; it gives the impression that something is wrong.

The nurse caring for the laboring woman should know that meconium is produced by:
A) Fetal intestines.
B) Fetal kidneys.
C) Amniotic fluid.
D) The placenta.

A woman asks the nurse, "What protects my baby's umbilical cord from being squashed while the baby's inside of me?" The nurse's best response is:
A) “Your baby’s umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby.”
B) “Your baby’s umbilical floats around in blood anyway.”
C) “You don’t need to worry about things like that.”
D) “The umbilical cord is a group of blood vessels that are very well protected by the placenta.”

A) “Your baby’s umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby.”
Feedback: "Your baby's umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby" is the most appropriate response. "Your baby's umbilical floats around in blood anyway" is inaccurate. "You don't need to worry about things like that" is not appropriate response. It negates the client's need for teaching and discounts her feelings. The placenta does not protect the umbilical cord. The cord is protected by the surrounding Wharton jelly.

A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine "several times" during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category?
A) Blood pressure, age, BMI
B) Drug/alcohol use, age, family history
C) Family history, blood pressure, BMI
D) Family history, BMI, drug/alcohol abuse

D) Family history, BMI, drug/alcohol abuse
Feedback: Her family history of NTD, low BMI, and substance abuse are all high risk factors of pregnancy. The woman's BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which would be a high risk. The woman's drug/alcohol use and family history put her in a high risk category, but her age does not. The woman's family history puts her in a high risk category. Her BMI is low and may indicate poor nutritional status, which would be high risk. Her BP is normal.

A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time?
A) Ultrasound examination
B) Maternal serum alpha-fetoprotein screening (MSAFP)
C) Amniocentesis
D) Nonstress test (NST)

A) Ultrasound examination
Feedback: An ultrasound examination could be done to confirm the pregnancy and determine the gestational age of the fetus. It is too early in the pregnancy to perform the MSAFP, an amniocentesis, or an NST. The MSAFP is performed at 16 to 18 weeks of gestation, followed by amniocentesis if the MSAFP levels are abnormal or if fetal/maternal anomalies are detected. An NST is performed to assess fetal well-being in the third trimester.

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis?
A) Doppler blood flow analysis
B) Contraction stress test (CST)
C) Amniocentesis
D) Daily fetal movement counts

A) Doppler blood flow analysis
Feedback: Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.

A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus?
A) Ultrasound for fetal anomalies
B) Biophysical profile (BPP)
C) Maternal serum alpha-fetoprotein screening (MSAFP)
D) Percutaneous umbilical blood sampling (PUBS)

B) Biophysical profile (BPP)
Feedback: Real-time ultrasound permits detailed assessment of the physical and physiologic characteristics of the developing fetus and cataloging of normal and abnormal biophysical responses to stimuli. The BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal anomalies would most likely have occurred earlier in the pregnancy. It is too late in the pregnancy to perform an MSAFP. Furthermore, it does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.

A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time?
A) Biophysical profile
B) Amniocentesis
C) Maternal serum alpha-fetoprotein (MSAFP)
D) Transvaginal ultrasound

D) Transvaginal ultrasound
Feedback: An ultrasound is the method of biophysical assessment of the infant that would be performed at this gestational age. A biophysical profile would be a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. An MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal).

A maternal serum alpha-fetoprotein (AFP) test indicates an elevated level. It is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus?
A) Percutaneous umbilical blood sampling (PUBS)
B) Ultrasound for fetal anomalies
C) Biophysical profile (BPP) for fetal well-being
D) Amniocentesis for genetic anomalies

B) Ultrasound for fetal anomalies
Feedback: If AFP findings are abnormal, follow-up procedures include genetic counseling for families with a history of neural tube defect, repeated AFP, ultrasound examination, and possibly amniocentesis. Indications for use of PUBS include prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. A BPP is a method of assessing fetal well-being in the third trimester. Before an amniocentesis is considered, the client first would have an ultrasound for direct visualization of the fetus.

Nurses should be aware that the biophysical profile (BPP):
A) Is an accurate indicator of impending fetal death.
B) Is a compilation of health risk factors of the mother during the later stages of pregnancy.
C) Consists of a Doppler blood flow analysis and an amniotic fluid index.
D) Involves an invasive form of ultrasonic examination.

A) Is an accurate indicator of impending fetal death.
Feedback: An abnormal BPP score is one indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.

With regard to amniocentesis, nurses should be aware that:
A) Because of new imaging techniques, it is now possible in the first trimester.
B) Despite the use of ultrasonography, complications still occur in the mother or infant in 5% to 10% of cases.
C) The shake test, or bubble stability test, is a quick means of determining fetal maturity.
D) The presence of meconium in the amniotic fluid is always cause for concern.

C) The shake test, or bubble stability test, is a quick means of determining fetal maturity.
Feedback: Diluted fluid is mixed with ethanol and shaken. After 15 minutes the bubbles tell the story. Amniocentesis is possible after the fourteenth week of pregnancy when the uterus becomes an abdominal organ. Complications occur in less than 1% of cases; many have been minimized or eliminated through the use of ultrasonography. Meconium in the amniotic fluid before the beginning of labor is not usually a problem.

A woman has been diagnosed with a high risk pregnancy. She and her husband come into the office in a very anxious state. She seems to be coping by withdrawing from the discussion, showing declining interest. The nurse can best help the couple by:
A) Telling her that the physician will isolate the problem with more tests.
B) Encouraging her and urging her to continue with childbirth classes.
C) Becoming assertive and laying out the decisions the couple needs to make.
D) Downplaying her risks by citing success rate studies.

B) Encouraging her and urging her to continue with childbirth classes.
Feedback: The nurse can best help the woman and her family regain a sense of control in their lives by providing support and encouragement (including active involvement in preparations and classes). The nurse can try to present opportunities for the couple to make as many choices as possible in prenatal care.

In the past factors to determine whether a woman was likely to develop a high risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high risk pregnancy has been adopted today. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. These categories include all of these except:
A) Biophysical.
B) Psychosocial.
C) Geographic.
D) Environmental

C) Geographic.
D) Environmental
Feedback: This category is correctly referred to as sociodemographic risk. These factors stem from the mother and her family. Ethnicity may be one of the risks to pregnancy; however, it is not the only factor in this category. Low income, lack of prenatal care, age, parity, and marital status also are included. Biophysical is one of the broad categories used for determining risk. These include genetic considerations, nutritional status, and medical and obstetric disorders. Psychosocial risks include smoking, caffeine, drugs, alcohol, and psychologic status. All of these adverse lifestyles can have a negative effect on the health of the mother or fetus. Environmental risks are those that can affect both fertility and fetal development. These include infections, chemicals, radiation, pesticides, illicit drugs, and industrial pollutants.

A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?
A) 3-1-1-1-3
B) 4-1-2-0-4
C) 3-0-3-0-3
D) 4-2-1-0-3

B) 4-1-2-0-4
Feedback: The correct calculation of this woman's gravidity and parity is 4-1-2-0-4.
The numbers reflect the woman's gravidity and parity information. Using the GPTAL system, her information is calculated as:
G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time.
T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term.
P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm.
A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not.
L: This number signifies the number of children born that currently are living; the woman has four children.

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system?
A) 2-0-0-1-1
B) 2-1-0-1-0
C) 3-1-0-1-0
D) 3-0-1-1-0

C) 3-1-0-1-0
Feedback: The correct calculation of this woman's gravidity and parity is 3-1-0-1-0.
Using the GPTAL system explained in question 1, this client's gravidity and parity information is calculated as follows:
G: Total number of times the woman has been pregnant (she is pregnant for the third time)
T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term)
P: Number of pregnancies that resulted in a preterm birth (none)
A: Abortions or miscarriages before the period of viability (she has had one)
L: Number of children born who are currently living (she has no living children)

A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have:
A) Amenorrhea.
B) Positive pregnancy test.
C) Chadwick’s sign.
D) Hegar’s sign.

A) Amenorrhea.
Feedback: Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman. A positive pregnancy test, the presence of Chadwick's sign, and the presence of Hegar's sign would all be probable signs of pregnancy.

The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is:
A) A positive pregnancy test.
B) Fetal movement palpated by the nurse-midwife.
C) Braxton Hicks contractions.
D) Quickening.

B) Fetal movement palpated by the nurse-midwife.
Feedback: Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. A positive pregnancy test and Braxton Hicks contractions would be probable signs of pregnancy. Quickening would be a presumptive sign of pregnancy.

A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level?
A) Not palpable above the symphysis at this time
B) Slightly above the symphysis pubis
C) At the level of the umbilicus
D) Slightly above the umbilicus

B) Slightly above the symphysis pubis
Feedback: In normal pregnancies the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy. As the uterus grows, it may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy. The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation.

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?
A) Less audible heart sounds (S1, S2)
B) Increased pulse rate
C) Increased blood pressure
D) Decreased red blood cell (RBC) production

B) Increased pulse rate
Feedback: Between 14 and 20 weeks of gestation the pulse increases about 10 to 15 beats/min, which persists to term. Splitting of S1 and S2 is more audible. In the first trimester blood pressure usually remains the same as at the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.

A number of changes in the integumentary system occur during pregnancy. What change persists after birth?
A) Epulis
B) Chloasma
C) Telangiectasia
D) Striae gravidarum

D) Striae gravidarum
Feedback: Striae gravidarum, or stretch marks, reflect separation within the underlying connective tissue of the skin. After birth they usually fade, although they never disappear completely. An epulis is a red, raised nodule on the gums that bleeds easily. Chloasma, or mask of pregnancy, is a blotchy, brown hyperpigmentation of the skin over the cheeks, nose, and forehead, especially in dark-complexioned pregnant women. Chloasma usually fades after the birth. Telangiectasia, or vascular spiders, are tiny, star-shaped or branchlike, slightly raised, pulsating end-arterioles usually found on the neck, thorax, face, and arms. They occur as a result of elevated levels of circulating estrogen. These usually disappear after birth.

The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change?
A) Her center of gravity will shift backward.
B) She will have increased lordosis.
C) She will have increased abdominal muscle tone.
D) She will notice decreased mobility of her pelvic joints.

B) She will have increased lordosis.
Feedback: An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain her balance. The center of gravity shifts forward. She will have decreased muscle tone. She will notice increased mobility of her pelvic joints.

A 31-year-old woman believes that she may be pregnant. She took an OTC pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview the nurse inquires about the woman's last menstrual period and asks whether she is taking any medications. The woman states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which reveals that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?
A) She took the pregnancy test too early.
B) She takes anticonvulsants.
C) She has a fibroid tumor.
D) She has been under considerable stress and has a hormone imbalance.

B) She takes anticonvulsants.
Feedback: Anticonvulsants may cause false-positive pregnancy test results. OTC pregnancy tests use enzyme-linked immunosorbent assay technology, which can yield positive results as soon as 4 days after implantation. Implantation occurs 6 to 10 days after conception. If the woman were pregnant, she would be into her third week at this point (having missed her period 1 week ago). Fibroid tumors do not produce hormones and have no bearing on hCG pregnancy tests. Although stress may interrupt normal hormone cycles (menstrual cycles), it does not affect human chorionic gonadotropin levels or produce positive pregnancy test results.

Appendicitis may be difficult to diagnose in pregnancy because the appendix is:
A) Displaced upward and laterally, high and to the right.
B) Displaced upward and laterally, high and to the left.
C) Deep at McBurney point.
D) Displaced downward and laterally, low and to the right.

A) Displaced upward and laterally, high and to the right.
Feedback: The appendix is displaced high and to the right, beyond McBurney point.

Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and therefore the basis for many tests. A maternity nurse should be aware that:
A) hCG can be detected as early as 2.5 weeks after conception.
B) The hCG level increases gradually and uniformly throughout pregnancy.
C) Much lower than normal increases in the level of hCG may indicate a postdate pregnancy.
D) A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.

D) A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.
Feedback: Higher levels also could be a sign of multiple gestation. hCG can be detected as early as 7 to 10 days after conception. The hCG level fluctuates during pregnancy: peaking, declining, stabilizing, and increasing again. Abnormally slow increases may indicate impending miscarriage.

To reassure and educate pregnant clients about changes in the uterus, nurses should be aware that:
A) Lightening occurs near the end of the second trimester as the uterus rises into a different position.
B) The woman’s increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening.
C) Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise.
D) The uterine souffle is the movement of the fetus.

B) The woman’s increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening.
Feedback: The softening of the lower uterine segment is called Hegar's sign. Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop. The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.

The nurse caring for the newly pregnant woman would advise her that ideally prenatal care should begin:
A) Before the first missed menstrual period.
B) After the first missed menstrual period.
C) After the second missed menstrual period.
D) After the third missed menstrual period.

B) After the first missed menstrual period.
Feedback: Prenatal care ideally should begin soon after the first missed menstrual period. Regular prenatal visits offer opportunities to ensure the health of the expectant mother and her infant.

A woman arrives at the clinic for a pregnancy test. The first day of her last menstrual period (LMP) was February 14, 2010. Her expected date of birth (EDB) would be:
A) September 17, 2010.
B) November 7, 2010.
C) November 21, 2010.
D) December 17, 2010.

C) November 21, 2010.
Feedback: Using Nägele's rule, November 21, 2010, is the correct expected date of birth. The EDB is calculated by subtracting 3 months from the first day of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2010:
February 14, 2010 – 3 months = November 14, 2009 + 7 days = November 21, 2009 + 1 year = November 21, 2010

Prenatal testing for the human immunodeficiency virus (HIV) is recommended for:
A) All women, regardless of risk factors.
B) A woman who has had more than one sexual partner.
C) A woman who has had a sexually transmitted infection.
D) A woman who is monogamous with her partner.

A) All women, regardless of risk factors.
Feedback: Testing for the antibody to HIV is strongly recommended for all pregnant women. An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated.

Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider?
A) Nausea with occasional vomiting
B) Fatigue
C) Urinary frequency
D) Vaginal bleeding

D) Vaginal bleeding
Feedback: Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of potential complications of the pregnancy. Nausea with occasional vomiting, fatigue, and urinary frequency are normal first-trimester complaints. Although they may be worrisome or annoying to the mother, they usually are not indications of pregnancy problems.

B) Baseline BP 100/70, current BP 130/85
Feedback: An increase in the systolic BP of 30 mm Hg or more over the baseline pressure or an increase in the diastolic BP of 15 mm Hg or more over the baseline pressure is a significant finding, regardless of the absolute values. A current BP of 130/85 indicates that such increases have occurred in both the diastolic and systolic pressures. A slight increase in BP of 126/85 does not meet the criteria for concern. Although the baseline BP is worrisome (an absolute systolic BP of 140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher suggests hypertension), the subsequent pressures have decreased, not increased. The BP of 110/60 is within normal limits for both values and is not a concern.

A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. The nurse would recommend that she:
A) Do Kegel exercises.
B) Do pelvic rock exercises.
C) Use a softer mattress.
D) Stay in bed for 24 hours.

B) Do pelvic rock exercises.
Feedback: Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Kegel exercises increase the tone of the pelvic area, not the back. A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain. Stretching and other exercises to relieve back pain should be performed several times a day.

Which statement about pregnancy is accurate?
A) A normal pregnancy lasts about 10 lunar months.
B) A trimester is one third of a year.
C) The prenatal period extends from fertilization to conception.
D) The estimated date of confinement (EDC) is how long the mother will have to be bedridden after birth.

A) A normal pregnancy lasts about 10 lunar months.
Feedback: A lunar month lasts 28 days, or 4 weeks. Pregnancy spans 9 calendar months but 10 lunar months. A trimester is one third of a normal pregnancy, or about 13 to 14 weeks. The prenatal period covers the full course of pregnancy (prenatal means before birth). The EDC is now called the EDB, or estimated date of birth. It has nothing to do with the duration of bed rest.

In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that:
A) Nonacceptance of the pregnancy very often equates to rejection of the child.
B) Mood swings most likely are the result of worries about finances and a changed lifestyle, as well as profound hormonal changes.
C) Ambivalent feelings during pregnancy usually are seen only in emotionally immature or very young mothers.
D) Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy, because they will resolve themselves naturally after birth.

B) Mood swings most likely are the result of worries about finances and a changed lifestyle, as well as profound hormonal changes.
Feedback: Mood swings are natural and are likely to affect every woman to some degree. A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Ambivalent feelings about pregnancy are normal for mature or immature women, young or older. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need to be resolved. The baby ends the pregnancy but not all the issues.

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lb) since conception. How would the nurse interpret this?
A) This weight gain indicates possible gestational hypertension.
B) This weight gain indicates that the woman’s infant is at risk for intrauterine growth restriction (IUGR).
C) This weight gain cannot be evaluated until the woman has been observed for several more weeks.
D) The woman’s weight gain is appropriate for this stage of pregnancy.

D) The woman’s weight gain is appropriate for this stage of pregnancy.
Feedback: The woman's weight gain is appropriate for this stage of pregnancy is an accurate statement. This woman's BMI is in the normal range. During the first trimester the average total weight gain is only 1 to 2.5 kg. Although weight gain does indicate possible gestational, it does not apply to this client. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy. Although weight gain does indicate risk for IUGR, it does not apply to this client. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy. Weight gain should take place throughout the pregnancy. The optimal rate of weight gain depends on the stage of the pregnancy.

C) Black bean soup, wheat crackers, ambrosia (orange sections, coconut, and pecans), and prunes
Feedback: Food sources that are rich in iron include liver, meats, whole grain or enriched breads and cereals, deep green leafy vegetables, legumes, and dried fruits. The foods in this group are all good sources of iron. In addition, the vitamin C in ambrosia (orange sections) aids absorption. Dairy products and tea are not sources of iron.

A pregnant woman experiencing nausea and vomiting should:
A) Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning.
B) Eat small, frequent meals (every 2 to 3 hours).
C) Increase her intake of high-fat foods to keep the stomach full and coated.
D) Limit fluid intake throughout the day.

B) Eat small, frequent meals (every 2 to 3 hours).
Feedback: Eating small, frequent meals is a correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated, but should compensate by drinking fluids at other times. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried and other fatty foods.

A woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman:
A) Substitute other calcium sources for milk in her diet.
B) Lie down after each meal.
C) Reduce the amount of fiber she consumes.
D) Eat five small meals daily.

D) Eat five small meals daily.
Feedback: Eating small, frequent meals may help with heartburn, nausea, and vomiting. Substituting other calcium sources for milk, lying down after eating, and reducing fiber intake are inappropriate dietary suggestions for all pregnant women, and do not alleviate heartburn.

Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet?
A) Fat-soluble vitamins A and D
B) Water-soluble vitamins C and B6
C) Iron and folate
D) Calcium and zinc

C) Iron and folate
Feedback: Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Zinc sometimes is supplemented. Most women get enough calcium.

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the client states:
A) “I will need to increase my insulin dosage during the first 3 months of pregnancy.”
B) “Insulin dosage will likely need to be increased during the second and third trimesters.”
C) “Episodes of hypoglycemia are more likely to occur during the first 3 months.”
D) “Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding.”

A) “I will need to increase my insulin dosage during the first 3 months of pregnancy.”
Feedback: Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. "Insulin dosage will likely need to be increased during the second and third trimesters," "Episodes of hypoglycemia are more likely to occur during the first 3 months," and "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding" are accurate statements and signify that the woman has understood the teachings regarding control of her diabetes during pregnancy.

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that:
A) Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
B) Hydramnios occurs approximately twice as often in diabetic pregnancies.
C) Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies.
D) Even mild-to-moderate hypoglycemic episodes can have significant effects on fetal well-being.

A) Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
Feedback: Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios occurs 10 times more often in diabetic pregnancies. Infections are more common and more serious in pregnant women with diabetes. Mild-to-moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being.

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:
A) With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern.
B) The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.
C) Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring.
D) At birth the neonate of a diabetic mother is no longer in any risk.

B) The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.
Feedback: Congenital malformations account for 30% to 50% of perinatal deaths. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.

The nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin Alc:
A) Is now done for all pregnant women, not just those with or likely to have diabetes.
B) Is a snapshot of glucose control at the moment?
C) Would be considered evidence of good diabetes control with a result of 5% to 6%.
D) Is done on the patient’s urine, not her blood.

C) Would be considered evidence of good diabetes control with a result of 5% to 6%.
Feedback: A score of 5% to 6% indicates good control. This is an extra test for diabetic women, not one done for all pregnant women. This test defines glycemic control over the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are done on the blood.

An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life rather than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. The most appropriate diagnosis at this time is:
A) Risk for injury to the fetus related to birth trauma.
B) Noncompliance related to lack of understanding of diabetes and pregnancy and requirements of the treatment plan.
C) Deficient knowledge related to insulin administration.
D) Risk for injury to the mother related to hypoglycemia or hyperglycemia.

B) Noncompliance related to lack of understanding of diabetes and pregnancy and requirements of the treatment plan.
Feedback: Before a treatment plan is developed or goals for the outcome of care are outlined, this client must come to an understanding of diabetes and the potential effects on her pregnancy. She appears to have greater concern for changes to her social life than adoption of a new self-care regimen. Risk for injury to the fetus related to either placental insufficiency or birth trauma may come much later in the pregnancy. At this time the client is having difficulty acknowledging the adjustments that she needs to make to her lifestyle to care for herself during pregnancy. The client may not yet be on insulin. Insulin requirements increase with gestation. The importance of glycemic control must be part of health teaching for this client. However, she has not yet acknowledged that changes to her lifestyle need to be made and may not participate in the plan of care until understanding takes place.

A) Valvular disease.
Feedback: Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve stenosis. Prophylaxis for intrapartum endocarditis is not indicated for congestive heart disease, arrhythmias, or postmyocardial infarction.

While providing care in an obstetric setting, the nurse should understand that postpartum care of the woman with cardiac disease:
A) Is the same as that for any pregnant woman?
B) Includes rest, stool softeners, and monitoring of the effect of activity.
C) Includes ambulating frequently, alternating with active range of motion.
D) Includes limiting visits with the infant to once per day.

B) Includes rest, stool softeners, and monitoring of the effect of activity.
Feedback: Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluid. Care of the woman with cardiac disease in the postpartum period is tailored to the woman's functional capacity. The woman will be on bed rest to conserve energy and reduce the strain on the heart. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated.

A woman with asthma is experiencing a postpartum hemorrhage. Which drug would NOT be used to treat her bleeding because it may exacerbate her asthma?
A) Pitocin
B) Nonsteroidal antiinflammatory drugs (NSAIDs)
C) Hemabate
D) Fentanyl

C) Hemabate
Feedback: Prostaglandin derivatives should not be used to treat women with asthma, because they may exacerbate symptoms. Pitocin would be the drug of choice to treat this woman's bleeding because it would not exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not bleeding.

In providing nutritional counseling for the pregnant woman experiencing cholecystitis, the nurse would:
A) Assess the woman’s dietary history for adequate calories and proteins.
B) Instruct the woman that the bulk of calories should come from proteins.
C) Instruct the woman to eat a low-fat diet and avoid fried foods.
D) Instruct the woman to eat a low-cholesterol, low-salt diet.

C) Instruct the woman to eat a low-fat diet and avoid fried foods.
Feedback: Instructing the woman to eat a low-fat diet and avoid fried foods is appropriate nutritional counseling for this client. Caloric and protein intake do not predispose a woman to the development of cholecystitis. The woman should be instructed to limit protein intake and choose foods that are high in carbohydrates. A low-cholesterol diet may be the result of limiting fats. However, a low-salt diet is not indicated.

Women with hyperemesis gravidarum:
A) Are a majority, because 70% of all pregnant women suffer from it at some time?
B) Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.
C) Need intravenous (IV) fluid and nutrition for most of their pregnancy.
D) Often inspire similar, milder symptoms in their male partners and mothers.

B) Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.
C) Need intravenous (IV) fluid and nutrition for most of their pregnancy.
D) Often inspire similar, milder symptoms in their male partners and mothers
Feedback: Women with hyperemesis gravidarum have severe vomiting; however, treatment for several days sets things right in most cases. Although 70% of pregnant women experience nausea and vomiting, fewer than 1% proceed to this severe level. IV administration may be used at first to restore fluid levels, but they are seldom needed for very long. Women suffering from this condition want sympathy, because some authorities believe that difficult relationships with mothers and/or partners may be the cause.

Because pregnant women may need surgery during pregnancy, nurses should be aware that:
A) The diagnosis of appendicitis may be difficult, because the normal signs and symptoms mimic some normal changes in pregnancy.
B) Rupture of the appendix is less likely in pregnant women because of the close monitoring.
C) Surgery for intestinal obstructions should be delayed as long as possible because it usually affects the pregnancy.
D) When pregnancy takes over, a woman is less likely to have ovarian problems that require invasive responses.

A) The diagnosis of appendicitis may be difficult, because the normal signs and symptoms mimic some normal changes in pregnancy.
Feedback: Both appendicitis and pregnancy are linked with nausea, vomiting, and increased white blood cell count. Rupture of the appendix is two to three times more likely in pregnant women. Surgery to remove obstructions should be done right away. It usually does not affect the pregnancy. Pregnancy predisposes a woman to ovarian problems.

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?
A) Blood pressure (BP) increase to 138/86 mm Hg
B) Weight gain of 0.5 kg during the past 2 weeks
C) A dipstick value of 3+ for protein in her urine
D) Pitting pedal edema at the end of the day

C) A dipstick value of 3+ for protein in her urine
Feedback: Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. Generally hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or 15 mm Hg diastolic pressure. Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore the presence of edema is no longer considered diagnostic of preeclampsia.

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of:
A) Eclampsia.
B) Disseminated intravascular coagulation (DIC).
C) HELLP syndrome.
D) Idiopathic thrombocytopenia.

C) HELLP syndrome.
Feedback: HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). Eclampsia is determined by the presence of seizures. DIC is a potential complication associated with HELLP syndrome. Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia.

A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to:
A) Insert an oral airway.
B) Suction the mouth to prevent aspiration.
C) Administer oxygen by mask.
D) Stay with the client and call for help.

D) Stay with the client and call for help.
Feedback: If a client becomes eclamptic, the nurse should stay with him or her and call for help.
Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the client's head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the client's mouth. Oxygen would be administered after the convulsion has ended.

A) Hydralazine.
Feedback: Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity.

Your client is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration. She asks the nurse, "Why is it taking so long?" The most appropriate response by the nurse would be:
A) “The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor.”
B) “I don’t know why it is taking so long.”
C) “The length of labor varies for different women.”
D) “Your baby is just being stubborn.”

A) “The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor.”
Feedback: Because magnesium sulfate is a tocolytic agent, its use may increase the duration of labor. The amount of oxytocin needed to stimulate labor may be more than that needed for the woman who is not receiving magnesium sulfate. "I don't know why it is taking so long." is not an appropriate statement for the nurse to make. Although the length of labor does vary for difference women, the most likely reason this woman's labor is protracted is the tocolytic effects of magnesium sulfate. The behavior of the fetus has no bearing on the length of labor.

Nurses should be aware that HELLP syndrome:
A) Is a mild form of preeclampsia?
B) Can be diagnosed by a nurse alert to its symptoms.
C) Is characterized by hemolysis, elevated liver enzymes, and low platelets.
D) Is associated with preterm labor but not perinatal mortality.

C) Is characterized by hemolysis, elevated liver enzymes, and low platelets.
D) Is associated with preterm labor but not perinatal mortality.
Feedback: The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. HELLP syndrome is difficult to identify because the symptoms often are not obvious. It must be diagnosed in the laboratory. Preterm labor is greatly increased and so is perinatal mortality.

C) Prevent and treat convulsions.
Feedback: Magnesium sulfate is the drug of choice to prevent convulsions, although it can generate other problems. Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity. Magnesium sulfate can increase the duration of labor. Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulfate therapy.

A new mother asks the nurse when the "soft spot" on her son's head will go away. The nurse's answer is based on the knowledge that the anterior fontanel closes after birth by _____ months.
A) 2
B) 8
C) 12
D) 18

D) 18
Feedback: The larger of the two fontanels, the anterior fontanel, closes by 18 months after birth.

When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal:
A) Lie.
B) Presentation.
C) Attitude.
D) Position.

C) Attitude.
Feedback: Attitude is the relation of the fetal body parts to one another. Lie is the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother. Presentation refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. Position is the relation of the presenting part to the four quadrants of the mother's pelvis.

When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline. What is the likely position of the fetus?
A) ROA
B) LSP
C) RSA
D) LOA

C) RSA
Feedback: The fetus is positioned anteriorly in the right side of the maternal pelvis with the sacrum as the presenting part. RSA is the correct three-letter abbreviation to indicate this fetal position. The first letter indicates the presenting part in either the right or left side of the maternal pelvis. The second letter indicates the anatomic presenting part of the fetus. The third letter stands for the location of the presenting part in relation to the anterior, posterior, or transverse portion of the maternal pelvis. Palpation of a round, firm fetal part in the fundal portion of the uterus would be the fetal head, indicating that the fetus is in a breech position with the sacrum as the presenting part in the maternal pelvis. Palpation of the fetal spine along the mother's right side denotes the location of the presenting part in the mother's pelvis. The ability to palpate the fetal spine indicates that the fetus is anteriorly positioned in the maternal pelvis.

The nurse has received a report about a woman in labor. The woman's last vaginal examination was recorded as 3 cm, 30%, and -2. The nurse's interpretation of this assessment is that:
A) The cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm above the ischial spines.
B) The cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines.
C) The cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm below the ischial spines.
D) The cervix is dilated 3 cm, it is effaced 30%, and the presenting part is 2 cm below the ischial spines.

B) The cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines.
Feedback: The correct description of the vaginal examination for this woman in labor is the cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines. The sterile vaginal examination is recorded as centimeters of cervical dilation, percentage of cervical dilation, and the relationship of the presenting part to the ischial spines (either above or below).

What position would be least effective when gravity is desired to assist in fetal descent?
A) Lithotomy
B) Kneeling
C) Sitting
D) Walking

A) Lithotomy
Feedback: The predominant position in the United States for physician-attended births is the lithotomy position, which requires a woman to be in a reclined position with her legs in stirrups. Gravity has little effect in this position. Kneeling, sitting, and walking help align the fetus with the pelvic outlet and allow gravity to assist in fetal descent.

Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased?
A) Semirecumbent
B) Sitting
C) Squatting
D) Side-lying

C) Squatting
Feedback: The squatting position may help increase the pelvic outlet. Kneeling or squatting moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet.

To adequately care for a laboring woman, the nurse knows that which stage of labor varies the most in length?
A) First
B) Second
C) Third
D) Fourth

A) First
Feedback: The first stage of labor is considered to last from the onset of regular uterine contractions to full dilation of the cervix. The first stage is much longer than the second and third stages combined. In a first-time pregnancy the first stage of labor can take up to 20 hours. The second stage of labor lasts from the time the cervix is fully dilated to the birth of the fetus. The average length is 20 minutes for a multiparous woman and 50 minutes for a nulliparous woman. The third stage of labor lasts from the birth of the fetus until the placenta is delivered. This stage may be as short as 3 minutes or as long as 1 hour. The fourth stage of labor, recovery, lasts about 2 hours after delivery of the placenta.

A) Increased cardiac output
Feedback: During each contraction 400 ml of blood is emptied from the uterus into the maternal vascular system. This increases cardiac output by about 10%, to 155, in the first stage of labor and by about 30% to 50% in the second stage. The heart rate increases slightly during labor. The WBC count can increase during labor. During the first stage of labor uterine contractions cause systolic readings to increase by about 10 mm Hg. During the second stage contractions may cause systolic pressures to increase by 30 mm Hg and diastolic readings to increase by 25 mm Hg.

The factors that affect the process of labor and birth, known commonly as the five Ps, include all except:
A) Passenger.
B) Passageway.
C) Powers.
D) Pressure.

D) Pressure.
Feedback: The five Ps are passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response.

The slight overlapping of cranial bones or shaping of the fetal head during labor is called:
A) Lightening.
B) Molding.
C) Ferguson reflex.
D) Valsalva maneuver.

B) Molding.
Feedback: Molding also permits adaptation to various diameters of the maternal pelvis. Lightening is the mother's sensation of decreased abdominal distention, which usually occurs the week before labor. Fetal head formation is called molding. The Ferguson reflex is the contraction urge of the uterus after stimulation of the cervix. Fetal head formation is called molding. The Valsalva maneuver describes conscious pushing during the second stage of labor. Fetal head formation is called molding.

Which presentation is described accurately in terms of both presenting part and frequency of occurrence?
A) Cephalic: occiput; at least 95%
B) Breech: sacrum; 10% to 15%
C) Shoulder: scapula; 10% to 15%
D) Cephalic: cranial; 80% to 85%

A) Cephalic: occiput; at least 95%
Feedback: In cephalic presentations (head first) the presenting part is the occiput; this occurs in 96% of births. In a breech birth the sacrum emerges first; this occurs in about 3% of births. In shoulder presentations the scapula emerges first; this occurs in only 1% of births. In a cephalic presentation the part of the head or cranium that emerges first is the occiput; cephalic presentations occur in 96% of births.

With regard to factors that affect how the fetus moves through the birth canal, nurses should be aware that:
A) The fetal attitude describes the angle at which the fetus exits the uterus.
B) Of the two primary fetal lies, the horizontal lie is that in which the long axis of the fetus is parallel to the long axis of the mother.
C) The normal attitude of the fetus is called general flexion.
D) The transverse lie is preferred for vaginal birth.

C) The normal attitude of the fetus is called general flexion.
Feedback: The normal attitude of the fetus is general flexion. The fetal attitude is the relation of fetal body parts to one another. The horizontal lie is perpendicular to the mother; in the longitudinal (or vertical) lie the long axes of the fetus and the mother are parallel. Vaginal birth cannot occur if the fetus stays in a transverse lie.

With regard to fetal positioning during labor, nurses should be aware that:
A) Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal.
B) Birth is imminent when the presenting part is at +4 to +5 cm, below the spine.
C) The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter.
D) Engagement is the term used to describe the beginning of labor.

B) Birth is imminent when the presenting part is at +4 to +5 cm, below the spine.
.
Feedback: The station of the presenting part should be noted at the beginning of labor so that the rate of descent can be determined. Position is the relation of the presenting part of the fetus to the four quadrants of the mother's pelvis; station is the measure of degree of descent. The largest diameter usually is the biparietal diameter. The suboccipitobregmatic diameter is the smallest, although one of the most critical. Engagement often occurs in the weeks just before labor in nulliparas and before or during labor in multiparas.

D) Platypelloid: flattened, wide, shallow; 3%
Feedback: A platypelloid pelvis is flattened, wide, and shallow; about 3% of women have this shape. The gynecoid shape is the classical female shape, slightly ovoid and rounded; about 50% of women have this shape. An android, or malelike, pelvis is heart shaped; about 23% of women have this shape. An anthropoid, or apelike, pelvis is oval and wider; about 24% of women have this shape.

With regard to primary and secondary powers, the maternity nurse should know that:
A) Primary powers are responsible for effacement and dilation of the cervix.
B) Effacement generally is well ahead of dilation in women giving birth for the first time; they are more together in subsequent pregnancies.
C) Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation.
D) Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs.

A) Primary powers are responsible for effacement and dilation of the cervix.
Feedback: The primary powers are responsible for dilation and effacement; secondary powers are concerned with expulsion of the fetus. Effacement generally is well ahead of dilation in first-timers; they are more together in subsequent pregnancies. Scarring of the cervix may slow dilation. Pushing is more effective and less fatiguing when the woman begins to push only after she has the urge to do so.

With regard to the position of the laboring woman, maternity nurses should be able to tell the woman that:
A) The supine position commonly used in the United States increases blood flow.
B) The “all fours” position, on her hands and knees, is hard on her back.
C) Frequent changes in position will help relieve her fatigue and increase her comfort.
D) In a sitting or squatting position her abdominal muscles will have to work harder.

C) Frequent changes in position will help relieve her fatigue and increase her comfort.
Feedback: Frequent position changes relieve fatigue, increase comfort, and improve circulation. Blood flow can be compromised in the supine position; any upright position benefits cardiac output. The "all fours" position is used to relieve backache in certain situations. In a sitting or squatting position the abdominal muscles work in greater harmony with uterine contractions.

Which description of the four stages of labor is correct for both definition and duration?
A) First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours
B) Second stage: full effacement to 4 to 5 cm; visible presenting part; 1 to 2 hours
C) Third state: active pushing to birth; 20 minutes (multiparous women), 50 minutes (first-timer)
D) Fourth stage: delivery of the placenta to recovery; 30 minutes to 1 hour

A) First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours
Feedback: Full dilation may occur in less than 1 hour, but in first-time pregnancies it can take up to 20 hours. The second stage extends from full dilation to birth and takes an average of 20 to 50 minutes, although 2 hours is still considered normal. The third stage extends from birth to expulsion of the placenta and usually takes a few minutes. The fourth stage begins after expulsion of the placenta and lasts until homeostasis is reestablished (about 2 hours).

With regard to the turns and other adjustments of the fetus during the birth process, known as the mechanism of labor, nurses should be aware that:
A) The seven critical movements must progress in a more or less orderly sequence.
B) Asynclitism sometimes is achieved by means of the Leopold maneuver.
C) The effects of the forces determining descent are modified by the shape of the woman’s pelvis and the size of the fetal head.
D) At birth the baby is said to achieve “restitution” (i.e., a return to the C-shape of the womb).

C) The effects of the forces determining descent are modified by the shape of the woman’s pelvis and the size of the fetal head.
Feedback: The size of the maternal pelvis and the ability of the fetal head to mold also affect the process. The seven identifiable movements of the mechanism of labor occur in combinations simultaneously, not in precise sequences. Asynclitism is the deflection of the baby's head; the Leopold maneuver is a means of judging descent by palpating the mother's abdomen. Restitution is the rotation of the baby's head after the infant is born.

To assess the health of the mother accurately during labor, the nurse should be aware that:
A) The woman’s blood pressure will increase during contractions and fall back to prelabor normal between contractions.
B) Use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia.
C) Having the woman point her toes will reduce leg cramps.
D) The endogenous endorphins released during labor will raise the woman’s pain threshold and produce sedation.

D) The endogenous endorphins released during labor will raise the woman’s pain threshold and produce sedation.
Feedback: The endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation. In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother's perception of pain. Blood pressure increases during contractions but remains somewhat elevated between them. Use of the Valsalva maneuver is discouraged during second stage labor for a number of unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the process of labor itself.

A) Lightening.
C) Bloody show.
D) Rupture of membranes.
Feedback: Signs that precede labor may include lightening, urinary frequency, backache, weight loss, surge of energy, bloody show, and rupture of membranes. Many women experience a burst of energy before labor. A decrease in fetal movement is an ominous sign that does not always correlate with labor.

An OB/GYN nurse is teaching a class on medications that affect uterine function. The nurse asks the class, "What is the purpose of tocolytic agents?" Which response by a member of the class indicates a correct understanding of the purpose of these drugs? "Tocolytics are used to
A) Augment labor.”
B) Control postpartum bleeding.”
C) Induce abortion.”
D) Suppress preterm labor.”

D) Suppress preterm labor.”
Feedback: Tocolytic agents are used to suppress preterm labor. Tocolytic agents are not used to induce labor, induce abortion, or control postpartum bleeding.

The nurse has just administered intravenous (IV) methylergonovine (Methergine) to a postpartum patient to prevent bleeding. Later in the shift, the patient begins to vomit and complains of nausea and a headache. The nurse initially should assess the patient's
A) Bleeding status.
B) Blood pressure.
C) Headache.
D) Renal function.

B) Blood pressure.
Feedback: The nurse should assess the patient's blood pressure first. Hypertension can be severe and may be associated with nausea, vomiting, headache, and convulsions. Death also is possible. Nothing indicates that the patient's bleeding status needs to be checked; the symptoms described are associated with hypervolemia. Migraine may occur with methylergonovine, but the initial assessment should be the blood pressure. Nothing indicates that the kidneys are being affected.

An obstetrical nurse is caring for a patient in preterm labor. The nurse implements an order for IV magnesium sulfate. Which clinical manifestations would indicate that the patient has received too much of the medication?
A) Temperature of 104.4° F
B) Paralytic ileus
C) Hypertension
D) Confusion

The nurse is monitoring a patient who is having her sixth child. The patient has gone beyond term, and labor is being induced with oxytocin (Pitocin). The nurse understands that this patient is at risk for
A) Hemorrhage.
B) Placental insufficiency.
C) Uterine rupture.
D) Water intoxication.

C) Uterine rupture.
Feedback: Induction of labor in women of high parity (five or more pregnancies) carries a high risk of uterine rupture, and oxytocin should be used with great caution. Oxytocin poses no apparent risk of hemorrhage or placental insufficiency. The patient would be at risk for water intoxication if high doses of oxytocin were being administered.

A) Contractions lasting longer than 60 seconds
Feedback: The nurse would discontinue the medication if contractions lasting longer than 60 seconds occurred, because this may indicate maternal and/or fetal distress. Contractions occurring every 2 to 3 minutes are considered normal. Complications that usually require interruption of the infusion include elevation of the resting uterine pressure above 15 to 20 mm Hg, so this response is considered normal. The fetal heart rate of 130 beats per minute is normal and this response also says the fetal heart rate is regular.

The nurse on a postpartum unit is reviewing the medication administration record of a patient receiving IV methylergonovine (Methergine). For which of the following patients would the nurse question the order?
A) The patient with diabetes
B) The patient with a urinary tract infection (UTI)
C) The patient with a migraine
D) The patient with hypertension

D) The patient with hypertension
Feedback: Hypertension can be severe and may be associated with nausea, vomiting, and headache; convulsions and death have occurred. Nothing indicates that diabetes or a UTI is a contraindication for use of this medication. Migraine is not a contraindication; however, methylergonovine may cause migraine because of its vasodilative effect.

During a postpartum assessment, a nurse discovers a boggy uterus and increased vaginal bleeding. The patient has been unable to tolerate oxytocin or carboprost tromethamine (Hemabate). The nurse anticipates the administration of which drug?
A) Prostaglandin E
B) Ergonovine (Ergotrate)
C) Terbutaline (Brethine)
D) Clomiphene (Clomid)

B) Ergonovine (Ergotrate)
Feedback: The nurse should anticipate the administration of ergonovine, which is indicated for vaginal bleeding. Ergonovine is indicated in patients who are unable to tolerate oxytocin or carboprost tromethamine. Neither prostaglandin E nor clomiphene is indicated in the treatment of vaginal bleeding. Terbutaline is not indicated in the treatment of vaginal bleeding.

Running by the nurses' station, the prescriber tells the nurse to prepare for IV administration of ergonovine (Ergotrate) stat. The nurse quickly gets the medication and enters the patient's room. What clinical manifestation would the nurse expect the patient to show?
A) Excessive bleeding
B) Water intoxication
C) Active labor
D) Hypertension

A) Excessive bleeding
Feedback: The clinical manifestation the nurse should expect to see is hemorrhage. Water intoxication is associated with oxytocin administration, but the scenario does not state that the patient was receiving oxytocin. Ergot alkaloids are not recommended for use during labor. Ergonovine actually can cause hypertension.

The nurse is creating a plan of care for a patient in labor. Which nursing diagnosis would have priority for a patient receiving intravenous oxytocin (Pitocin)?
A) Risk for impaired comfort
B) Risk for urinary retention
C) Risk for nutrition, more than body requirements
D) Risk for fluid volume excess

D) Risk for fluid volume excess
Feedback: The most appropriate nursing diagnosis, which would take priority, is risk for fluid volume excess. IV oxytocin causes water retention, and the patient should be monitored for water intoxication. Oxytocin poses no risk for urinary retention or impaired comfort. There is no apparent indication that the patient is at risk for excess nutrition.

A nurse is creating a plan of care for an obstetrical patient receiving tocolytic medications. The nurse provides patient education about the medication. The nurse asks the patient, "What outcome do we want to see as a result of the tocolytic therapy?" Which response by the patient best demonstrates understanding of this medication?
A) “I will have sufficient milk production.”
B) “The medication will directly affect my comfort level.”
C) “The delivery will be postponed at least 24 hours.”
D) “My breasts will be soft but not engorged.”

C) “The delivery will be postponed at least 24 hours.”
Feedback: Tocolytic therapy is implemented to suppress preterm labor. Tocolytic therapy does not affect milk production or the breasts. Tocolytic therapy may indirectly affect the patient's comfort level by reducing contractions, but it does not directly affect comfort level.

The nurse is caring for several patients on an OB unit and is preparing to pass medications. For which patients would the nurse question an order for dinoprostone (Prepidil, Cervidil)? (Select all that apply.)
A) The patient in need of cervical ripening
B) The patient with premature labor
C) The patient with pelvic inflammatory disease (PID)
D) The patient with a history of liver disease
E) The patient with a history of asthma

B) The patient with premature labor
C) The patient with pelvic inflammatory disease (PID)
D) The patient with a history of liver disease
E) The patient with a history of asthma
Feedback: Indications for the use of dinoprostone include a patient in need of cervical ripening prior to induction of labor. Dinoprostone is contraindicated in patients with PID, liver disease, and lung disease. It is not used in patients with premature labor.

An 18-year-old pregnant woman, gravida 1, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The woman states, "My contractions are so strong that I don't know what to do." The nurse should:
A) Assess for fetal well-being.
B) Encourage the woman to lie on her side.
C) Disturb the woman as little as possible.
D) Recognize that pain is personalized for each individual.

D) Recognize that pain is personalized for each individual.
Feedback: Each woman's pain during childbirth is unique and is influenced by a variety of physiologic, psychosocial, and environmental factors. A critical issue for the nurse is how support can make a difference in the pain of the woman during labor and birth.
Assessing for fetal well-being includes no information that would indicate fetal distress or a logical reason to be overly concerned about the well-being of the fetus. The left lateral position is used to alleviate fetal distress, not maternal stress. The nurse has an obligation to provide physical, emotional, and psychosocial care and support to the laboring woman. This client clearly needs support.

Nursing care measures are commonly offered to women in labor. Which nursing measure reflects application of the gate-control theory?
A) Massaging the woman’s back
B) Changing the woman’s position
C) Giving the prescribed medication
D) Encouraging the woman to rest between contractions

A) Massaging the woman’s back
Feedback: According to the gate-control theory, pain sensations travel along sensory nerve pathways to the brain, but only a limited number of sensations, or messages, can travel through these nerve pathways at one time. Distraction techniques such as massage or stroking, music, focal points, and imagery reduce or completely block the capacity of nerve pathways to transmit pain. These distractions are thought to work by closing down a hypothetic gate in the spinal cord, thus preventing pain signals from reaching the brain. The perception of pain is thereby diminished. Changing the woman's position, giving prescribed medication, and encouraging rest do not reduce or block the capacity of nerve pathways to transmit pain using the gate-control theory.

A woman in labor has just received an epidural block. The most important nursing intervention is to:
A) Limit parenteral fluids.
B) Monitor the fetus for possible tachycardia.
C) Monitor the maternal blood pressure for possible hypotension.
D) Monitor the maternal pulse for possible bradycardia.

C) Monitor the maternal blood pressure for possible hypotension.
Feedback: The most important nursing intervention for a woman who has received an epidural block is to monitor the maternal blood pressure frequently for signs of hypotension. Intravenous fluids are increased for a woman receiving an epidural to prevent hypotension. The nurse observes for signs of fetal bradycardia. The nurse monitors for signs of maternal tachycardia secondary to hypotension.

The nurse should be aware that an effective plan to achieve adequate pain relief without maternal risk is most effective if:
A) The mother gives birth without any analgesic or anesthetic.
B) The mother and family’s priorities and preferences are incorporated into the plan.
C) The primary health care provider decides the best pain relief for the mother and family.
D) The nurse informs the family of all alternative methods of pain relief available in the hospital setting.

B) The mother and family’s priorities and preferences are incorporated into the plan.
Feedback: The assessment of the woman, her fetus, and her labor is a joint effort of the nurse and the primary health care providers, who consult with the woman about their findings and recommendations. The needs of each woman are different, and many factors must be considered before a decision is made whether pharmacologic methods, nonpharmacologic methods, or a combination of the two will be used to manage labor pain.

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use:
A) Counterpressure against the sacrum.
B) Pant-blow (breaths and puffs) breathing techniques.
C) Effleurage.
D) Conscious relaxation or guided imagery.

A) Counterpressure against the sacrum.
Feedback: Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. The pain management techniques of pant-blow, effleurage, and conscious relaxation or guided imagery are usually helpful for contraction per the gate-control theory.

If an opioid antagonist is administered to a laboring woman, she should be told that:
A) Her pain will decrease.
B) Her pain will return.
C) She will feel less anxious.
D) She will no longer feel the urge to push.

B) Her pain will return.
Feedback: The woman should be told that the pain that was relieved by the opioid analgesic will return with administration of the opioid antagonist. Opioid antagonists, such as Narcan, promptly reverse the central nervous system (CNS) depressant effects of opioids. In addition, the antagonist counters the effect of the stress-induced levels of endorphins. An opioid antagonist is especially valuable if labor is more rapid than expected and birth is anticipated when the opioid is at its peak effect.

A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman's intravenous fluid for a preprocedural bolus. She reviews her laboratory values and notes that the woman's hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for the woman?
A) She is too far dilated.
B) She is anemic.
C) She has thrombocytopenia.
D) She is septic.

C) She has thrombocytopenia.
Feedback: The platelet count indicates thrombocytopenia (low platelets), which is a contraindication to epidural analgesia/anesthesia. Typically epidural analgesia/anesthesia is used in the laboring woman when a regular labor pattern has been achieved, as evidenced by progressive cervical change. The laboratory values show that the woman's hemoglobin and hematocrit are in the normal range and show a slight increase in the WBC count; not uncommon in laboring women.

The role of the nurse with regard to informed consent is to:
A) Inform the client about the procedure and have her sign the consent form.
B) Act as a client advocate and help clarify the procedure and the options.
C) Call the physician to see the client.
D) Witness the signing of the consent form.

B) Act as a client advocate and help clarify the procedure and the options.
Feedback: Nurses play a part in the informed consent process by clarifying and describing procedures or by acting as the woman's advocate and asking the primary health care provider for further explanations. The physician is responsible for informing the woman of her options, explaining the procedure, and advising the client about potential risk factors. The physician must be present to explain the procedure to the client. However, the nurse's responsibilities go further than simply asking the physician to see the client. The nurse may witness the signing of the consent form. However, depending on the state's guidelines, the woman's husband or another hospital health care employee may sign as witness.

A first-time mother is concerned about the type of medications she will receive during labor. She is in a fair amount of pain and is nauseous. In addition, she appears to be very anxious. You explain that opioid analgesics often are used with sedatives because:
A) “The two together work the best for you and your baby.”
B) “Sedatives help the opioid work better, and they also will help relax you and relieve your nausea.”
C) “They work better together so you can sleep until you have the baby.”
D) “This is what the doctor has ordered for you.”

B) “Sedatives help the opioid work better, and they also will help relax you and relieve your nausea.”
Feedback: Sedatives can be used to reduce the nausea and vomiting that often accompany opioid use. In addition, some ataractics reduce anxiety and apprehension and potentiate the opioid analgesic affects. A potentiator may cause the two drugs to work together more effectively, but it does not ensure maternal or fetal complications. Sedation may be a related effect of some ataractics, but it is not the goal. Furthermore, a woman is unlikely to be able to sleep through transitional labor and birth. "This is what the doctor has ordered for you" may be true, but it is not an acceptable comment for the nurse to make.

To help clients manage discomfort and pain during labor, nurses should be aware that:
A) The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen.
B) Referred pain is the extreme discomfort between contractions.
C) The somatic pain of the second stage of labor is more generalized and related to fatigue.
D) Pain during the third stage is a somewhat milder version of the second stage.

A) The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen.
Feedback: This pain comes from cervical changes, distention of the lower uterine segment, and uterine ischemia. Referred pain occurs when the pain that originates in the uterus radiates to the abdominal wall, lumbosacral area of the back, iliac crests, and gluteal area. Second-stage labor pain is intense, sharp, burning, and localized. Third-stage labor pain is similar to that of the first stage.

Which statement correctly describes the effects of various pain factors?
A) Higher prostaglandin levels arising from dysmenorrhea can blunt the pain of childbirth.
B) Upright positions in labor increase the pain factor because they cause greater fatigue.
C) Women who move around trying different positions are experiencing more pain.
D) Levels of pain-mitigating β-endorphins are higher during a spontaneous, natural childbirth.

D) Levels of pain-mitigating β-endorphins are higher during a spontaneous, natural childbirth.
Feedback: Higher endorphin levels help women tolerate pain and reduce anxiety and irritability. Higher prostaglandin levels correspond to more severe labor pains. Upright positions in labor usually result in improved comfort and less pain. Moving freely to find more comfortable positions is important for reducing pain and muscle tension.

C) Prolonged umbilical cord compression.
Feedback: Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death. Bradycardia can result from placental transfer of drugs, prolonged compression of the umbilical cord, maternal hypothermia, and maternal hypotension. Intraamniotic infection, fetal anemia, and tocolytic treatment using ritodrine would most likely result in fetal tachycardia.

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse's first priority is to:
A) Change the woman’s position.
B) Notify the care provider.
C) Assist with amnioinfusion.
D) Insert a scalp electrode.

A) Change the woman’s position.
Feedback: Late decelerations may be caused by maternal supine hypotension syndrome. They usually are corrected when the woman turns on her side to displace the weight of the gravid uterus from the vena cava. If the fetus does not respond to primary nursing interventions for late decelerations, the nurse would continue with subsequent intrauterine resuscitation measures, including notifying the care provider. An amnioinfusion may be used to relieve pressure on an umbilical cord that has not prolapsed. The FHR pattern associated with this situation most likely reveals variable deceleration. A fetal scalp electrode would provide accurate data for evaluating the well-being of the fetus; however, this is not a nursing intervention that would alleviate late decelerations, nor is it the nurse's first priority.

A) Altered fetal cerebral blood flow.
Feedback: Early decelerations are the fetus's response to fetal head compression. Variable decelerations are associated with umbilical cord compression. Late decelerations are associated with uteroplacental insufficiency. Spontaneous rupture of membranes has no bearing on the fetal heart rate unless the umbilical cord prolapses, which would result in variable or prolonged bradycardia.

The nurse providing care for the laboring woman should understand that accelerations with fetal movement:
A) Are reassuring.
B) Are caused by umbilical cord compression.
C) Warrant close observation.
D) Are caused by uteroplacental insufficiency.

A) Are reassuring.
Feedback: Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal well-being. Umbilical cord compression results in variable decelerations in the FHR. Accelerations in the FHR are an indication of fetal well-being and do not warrant close observation. Uteroplacental insufficiency would result in late decelerations in the FHR.

B) Umbilical cord compression.
Feedback: Variable decelerations can occur any time during the uterine contracting phase and are caused by compression of the umbilical cord. Altered fetal cerebral blood flow would result in early decelerations in the FHR. Uteroplacental insufficiency would result in late decelerations in the FHR. Fetal hypoxemia would result in tachycardia initially and then bradycardia if hypoxia continues.

C) Uteroplacental insufficiency.
Feedback: Uteroplacental insufficiency would result in late decelerations in the FHR. Altered fetal cerebral blood flow would result in early decelerations in the FHR. Umbilical cord compression would result in variable decelerations in the FHR. Meconium-stained fluid may or may not produce changes in the fetal heart rate, depending on the gestational age of the fetus and whether other causative factors associated with fetal distress are present.

The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat:
A) Variable decelerations.
B) Late decelerations.
C) Fetal bradycardia.
D) Fetal tachycardia.

A) Variable decelerations.
Feedback: Amnioinfusion is used during labor to either dilute meconium-stained amniotic fluid or supplement the amount of amniotic fluid to reduce the severity of variable decelerations caused by cord compression. Amnioinfusion has no bearing on late decelerations, fetal bradycardia, or fetal tachycardia alterations in fetal heart rate (FHR) tracings.

The nurse caring for the woman in labor should understand that maternal hypotension can result in:
A) Early decelerations.
B) Fetal dysrhythmias.
C) Uteroplacental insufficiency.
D) Spontaneous rupture of membranes.

A) Change in position.
Feedback: Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This reduces venous return to the woman's heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and avoid the supine position. Oxytocin administration, regional anesthesia, and intravenous analgesic may reduce maternal cardiac output.

While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should:
A) Change the woman’s position.
B) Discontinue the oxytocin infusion.
C) Insert an internal monitor.
D) Document the finding in the client’s record.

D) Document the finding in the client’s record.
Feedback: The FHR indicates early decelerations, which are not an ominous sign and do not require any intervention. The nurse should simply document these findings.

Which fetal heart rate (FHR) finding would concern the nurse during labor?
A) Accelerations with fetal movement
B) Early decelerations
C) An average FHR of 126 beats/min
D) Late decelerations

D) Late decelerations
Feedback: Late decelerations are caused by uteroplacental insufficiency and are associated with fetal hypoxemia. They are considered ominous if persistent and uncorrected. Accelerations in the FHR are an indication of fetal well-being. Early decelerations in the FHR are associated with head compression as the fetus descends into the maternal pelvic outlet; they generally are not a concern during normal labor. This FHR finding is normal and not a concern.

D) Fetal sleep cycles.
Feedback: A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes. Altered fetal cerebral blood flow would result in early decelerations in the FHR. Fetal hypoxemia would be evidenced by tachycardia initially and then bradycardia. A persistent decrease or loss of FHR variability may be seen. Umbilical cord compression would result in variable decelerations in the FHR.

A) The response of the fetal heart rate (FHR) to uterine contractions (UCs).
Feedback: Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Maternal pain control is not the measure used to determine fetal well-being in labor. Although FHR accelerations are a reassuring pattern, they are only one component of the criteria by which fetal well-being is assessed. Although an FHR above 110 beats/min may be reassuring, it is only one component of the criteria by which fetal well-being is assessed. More information would be needed to determine fetal well-being.

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take?
A) Scream for help.
B) Insert a Foley catheter.
C) Start pitocin.
D) Notify the care provider immediately.

D) Notify the care provider immediately.
Feedback: To relieve an FHR deceleration, the nurse can reposition the mother, increase IV fluid, and provide oxygen. If oxytocin is infusing, it should be discontinued. If the FHR does not resolve, the primary care provider should be notified immediately. Inserting a Foley catheter is an inappropriate nursing action. If the FHR were to continue in a nonreassuring pattern, a cesarean section may be warranted, which would require a Foley catheter. However, the physician must make that determination. Pitocin may put additional stress on the fetus.

What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken.
A) Call the provider, reposition the mother, and perform a vaginal examination.
B) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.
C) Administer oxygen to the mother, increase IV fluid, and notify the care provider.
D) Perform a vaginal examination, reposition the mother, and provide oxygen via face mask.

B) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.
Feedback: Repositioning the mother, increasing intravenous (IV) fluid, and providing oxygen via face mask. are correct nursing actions for intrauterine resuscitation. The nurse should initiate intrauterine resuscitation in an ABC manner, similar to basic life support. The first priority is to open the maternal and fetal vascular systems by repositioning the mother for improved perfusion. The second priority is to increase blood volume by increasing the IV fluid. The third priority is to optimize oxygenation of the circulatory volume by providing oxygen via face mask. If these interventions do not resolve the fetal heart rate issue quickly, the primary provider should be notified immediately.

A) Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes.
Feedback: Nurses who care for women during childbirth are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on those patterns, and documenting the outcomes of those interventions. Greeting the client, assessing her, and starting an IV; applying the external fetal monitor and notifying the care provider; and making sure the woman is comfortable may be activities that a nurse performs, but are not activities for which the nurse is legally responsible.

As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with:
A) Hypotension.
B) Cord compression.
C) Maternal drug use.
D) Hypoxemia.

A new client and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the baby's heart rate should be. Your best response is:
A) “Don’t worry about that machine; that’s my job.”
B) “The top line graphs the baby’s heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor.”
C) “The top line graphs the baby’s heart rate, and the bottom line lets me know how strong the contractions are.”
D) “Your doctor will explain all of that later.”

B) “The top line graphs the baby’s heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor.”
Feedback: "The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor" educates the partner about fetal monitoring and provides support and information to alleviate his fears. "Don't worry about that machine; that's my job" discredits the partner's feelings and does not provide the teaching he is requesting. "The top line graphs the baby's heart rate, and the bottom line lets me know how strong the contractions are" provides inaccurate information and does not address the partner's concerns about the fetal heart rate. The EFM graphs the frequency and duration of the contractions, not the intensity. Nurses should take every opportunity to provide client and family teaching, especially when information is requested.

A) Contractions every 2 to 5 minutes.
Feedback: Contractions normally occur every 2 to 5 minutes and last less than 90 seconds (intensity 800 mm Hg) with about 30 seconds in between (20 mm Hg or less).

According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR):
A) Every 15 minutes in the active phase of the first stage of labor in the absence of risk factors.
B) Every 20 minutes in the second stage, regardless of whether risk factors are present.
C) Before and after ambulation and rupture of membranes.
D) More often in a woman’s first pregnancy.

C) Before and after ambulation and rupture of membranes.
Feedback: The FHR should be auscultated before and after administration of medications and induction of anesthesia. In the active phase of the first stage of labor, the FHR should be auscultated every 30 minutes if no risk factors are involved; with risk factors it should be auscultated every 15 minutes. In the second stage of labor the FHR should be auscultated every 15 minutes if no risk factors are involved; with risk factors it should be auscultated every 5 minutes. The fetus of a first-time mother is automatically at greater risk.

The nurse recognizes that a woman is in true labor when she states:
A) “I passed some thick, pink mucus when I urinated this morning.”
B) “My bag of waters just broke.”
C) “The contractions in my uterus are getting stronger and closer together.”
D) “My baby dropped, and I have to urinate more frequently now.”

C) “The contractions in my uterus are getting stronger and closer together.”
Feedback: Regular, strong contractions with the presence of cervical change indicate that the woman is experiencing true labor. Loss of the mucous plug (operculum) often occurs during the first stage of labor or before the onset of labor, but it is not the indicator of true labor. Spontaneous rupture of membranes often occurs during the first stage of labor, but it is not the indicator of true labor. The presenting part of the fetus typically becomes engaged in the pelvis at the onset of labor, but this is not the indicator of true labor.

The nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates the woman's understanding of the instructions when she states, "True labor contractions will:
A) Subside when I walk around.”
B) Cause discomfort over the top of my uterus.”
C) Continue and get stronger even if I relax and take a shower.”
D) Remain irregular but become stronger.”

C) Continue and get stronger even if I relax and take a shower.”
Feedback: True labor contractions occur regularly, becoming stronger, lasting longer, and occurring closer together. They may become intense during walking and continue despite comfort measures. Typically true labor contractions are felt in the lower back, radiating to the lower portion of the abdomen. During false labor, contractions tend to be irregular and felt in the abdomen above the navel. Typically the contractions often stop with walking or a change of position.

When a nulliparous woman telephones the hospital to report that she is in labor, the nurse initially should:
A) Tell the woman to stay home until her membranes rupture.
B) Emphasize that food and fluid intake should stop.
C) Arrange for the woman to come to the hospital for labor evaluation.
D) Ask the woman to describe why she believes she is in labor.

D) Ask the woman to describe why she believes she is in labor.
Feedback: Assessment begins at the first contact with the woman, whether by telephone or in person. By asking the woman to describe her signs and symptoms, the nurse can begin her assessment and gather data. The amniotic membranes may or may not spontaneously rupture during labor. The client may be instructed stay home until the uterine contractions become strong and regular. The nurse may want to discuss the appropriate oral intake for early labor such as light foods or clear liquids, depending on the preference of the client or her primary health care provider. Before instructing the woman to come to the hospital, the nurse should initiate her assessment during the telephone interview.

What is an expected characteristic of amniotic fluid?
A) Deep yellow color
B) Pale, straw color with small white particles
C) Acidic result on a Nitrazine test
D) Absence of ferning

B) Pale, straw color with small white particles
Feedback: Amniotic fluid normally is a pale, straw-colored fluid that may contain white flecks of vernix. Yellow-stained fluid may indicate fetal hypoxia up to 36 hours before rupture of membranes, fetal hemolytic disease, or intrauterine infection. Amniotic fluid produces an alkaline result on a Nitrazine test. The presence of ferning is a positive indication of amniotic fluid.

A) Intrauterine infection
Feedback: When the membranes rupture, microorganisms from the vagina can ascend into the amniotic sac, causing chorioamnionitis and placentitis. Rupture of membranes (ROM) is not associated with fetal or maternal bleeding. Although ROM may increase the intensity of contractions and facilitate active labor, it does not result in precipitous labor. ROM has no correlation with supine hypotension.

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to 70 mm Hg and the resting tone range is 6 to 10 mm Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the nurse should:
A) Notify the woman’s primary health care provider immediately.
B) Prepare to administer an oxytocic to stimulate uterine activity.
C) Document the findings because they reflect the expected contraction pattern for the active phase of labor.
D) Prepare the woman for the onset of the second stage of labor.

C) Document the findings because they reflect the expected contraction pattern for the active phase of labor.
Feedback: The nurse is responsible for monitoring the uterine contractions to ascertain whether they are powerful and frequent enough to accomplish the work of expelling the fetus and the placenta. In addition, the nurse would document these findings in the client's medical record. This labor pattern indicates that the client is in the active phase of the first stage of labor. Nothing indicates a need to notify the primary care provider at this time. Oxytocin augmentation is not needed for this labor pattern; this contraction pattern indicates adequate active labor. This labor pattern indicates that the woman is in active labor. Her contractions eventually will become stronger, last longer, and come closer together during the transition phase of the first stage of labor. The transition phase precedes the second stage of labor, or delivery of the fetus.

Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions?
A) Place the hand on the abdomen below the umbilicus and palpate uterine tone with the fingertips.
B) Determine the frequency by timing from the end of one contraction to the end of the next contraction.
C) Evaluate the intensity by pressing the fingertips into the uterine fundus.
D) Assess uterine contractions every 30 minutes throughout the first stage of labor.

C) Evaluate the intensity by pressing the fingertips into the uterine fundus.
Feedback: The nurse or primary care provider may assess uterine activity by palpating the fundal section of the uterus using the fingertips. Many women may experience labor pain in the lower segment of the uterus, which may be unrelated to the firmness of the contraction detectable in the uterine fundus. The frequency of uterine contractions is determined by palpating from the beginning of one contraction to the beginning of the next contraction. Assessment of uterine activity is performed in intervals based on the stage of labor. As labor progresses this assessment is performed more frequently.

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign that uterine contractions are effective would be:
A) Dilation of the cervix.
B) Descent of the fetus.
C) Rupture of the amniotic membranes.
D) Increase in bloody show.

A) Dilation of the cervix.
Feedback: The vaginal examination reveals whether the woman is in true labor. Cervical change, especially dilation, in the presence of adequate labor indicates that the woman is in true labor. Descent of the fetus, or engagement, may occur before labor. Rupture of membranes may occur with or without the presence of labor. Bloody show may indicate slow, progressive cervical change (e.g., effacement) in both true and false labor.

The nurse who performs vaginal examinations to assess a woman's progress in labor should:
A) Perform an examination at least once every hour during the active phase of labor.
B) Perform the examination with the woman in the supine position.
C) Wear two clean gloves for each examination.
D) Discuss the findings with the woman and her partner.

D) Discuss the findings with the woman and her partner.
Feedback: The nurse should discuss the findings of the vaginal examination with the woman and her partner and report them to the primary care provider. A vaginal examination should be performed only when indicated by the status of the woman and her fetus. The woman should be positioned to avoid supine hypotension. The examiner should wear a sterile glove while performing a vaginal examination for a laboring woman.

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse's initial response would be to:
A) Prepare the woman for imminent birth.
B) Notify the woman’s primary health care provider.
C) Document the characteristics of the fluid.
D) Assess the fetal heart rate and pattern.

D) Assess the fetal heart rate and pattern.
Feedback: The umbilical cord may prolapse when the membranes rupture. The fetal heart rate and pattern should be monitored closely for several minutes immediately after ROM to ascertain fetal well-being, and the findings should be documented. Rupture of membranes (ROM) may increase the intensity and frequency of the uterine contractions, but it does not indicate that birth is imminent. The nurse may notify the primary care provider after ROM occurs and the fetal well-being and response to ROM have been assessed. The nurse's priority is to assess fetal well-being. The nurse should document the characteristics of the amniotic fluid, but the initial response is to assess fetal well-being and the response to ROM.

A nulliparous woman who has just begun the second stage of her labor would most likely:
A) Experience a strong urge to bear down.
B) Show perineal bulging.
C) Feel tired yet relieved that the worst is over.
D) Show an increase in bright red bloody show.

C) Feel tired yet relieved that the worst is over.
Feedback: Common maternal behaviors during the latent phase of the second stage of labor include feeling a sense of accomplishment and optimism because "the worst is over." During the latent phase of the second stage of labor, the urge to bear down often is absent or only slight during the acme of contractions. Perineal bulging occurs during the transition phase of the second stage of labor, not at the beginning of the second stage. An increase in bright red bloody show occurs during the descent phase of the second stage of labor.

The nurse knows that the second stage of labor, the descent phase, has begun when:
A) The amniotic membranes rupture.
B) The cervix cannot be felt during a vaginal examination.
C) The woman experiences a strong urge to bear down.
D) The presenting part is below the ischial spines.

C) The woman experiences a strong urge to bear down.
Feedback: During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Rupture of membranes has no significance in determining the stage of labor. The second stage of labor begins with full cervical dilation. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as 5-cm dilation.

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include:
A) Encouraging the woman to try various upright positions, including squatting and standing.
B) Telling the woman to start pushing as soon as her cervix is fully dilated.
C) Continuing an epidural anesthetic so pain is reduced and the woman can relax.
D) Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction.

A) Encouraging the woman to try various upright positions, including squatting and standing.
Feedback: Upright positions and squatting both may enhance the progress of fetal descent. Many factors dictate when a woman will begin pushing. Complete cervical dilation is necessary, but it is only one factor. If the fetal head is still in a higher pelvic station, the physician or midwife may allow the woman to "labor down" (allowing more time for fetal descent, thereby reducing the amount of pushing needed) if the woman is able. The epidural may mask the sensations and muscle control needed for the woman to push effectively. Closed glottic breathing may trigger the Valsalva maneuver, which increases intrathoracic and cardiovascular pressures, reducing cardiac output and inhibiting perfusion of the uterus and placenta. In addition, holding the breath for longer than 5 to 7 seconds diminishes the perfusion of oxygen across the placenta, resulting in fetal hypoxia.

Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3.5 to 4 minutes. The nurse would report this as:
A) First stage, latent phase
B) First stage, active phase
C) First stage, transition phase
D) Second stage, latent phase

B) First stage, active phase
Feedback: The first stage, active phase of maternal progress indicates that the woman is in the active phase of the first stage of labor. During the latent phase of the first stage of labor, the expected maternal progress would be 0 to 3 cm dilation with contractions every 5 to 30 minutes. During the transition phase of the first stage of labor, the expected maternal progress is 8 to 10 cm dilation with contractions every 2 to 3 minutes. During the latent phase of the second stage of labor, the woman is completely dilated and experiences a restful period of "laboring down."

The most critical nursing action in caring for the newborn immediately after birth is:
A) Keeping the newborn’s airway clear.
B) Fostering parent-newborn attachment.
C) Drying the newborn and wrapping the infant in a blanket.
D) Administering eye drops and vitamin K.

A) Keeping the newborn’s airway clear.
Feedback: The care given immediately after the birth focuses on assessing and stabilizing the newborn. Although fostering parent-infant attachment is an important task for the nurse, it is not the most critical nursing action in caring for the newborn immediately after birth. The nursing activities would be (in order of importance) to maintain a patent airway, support respiratory effort, and prevent cold stress by drying the newborn and covering the infant with a warmed blanket or placing the newborn under a radiant warmer. After the newborn has been stabilized, the nurse assesses the newborn's physical condition, weighs and measures the newborn, administers prophylactic eye ointment and a vitamin K injection, affixes an identification bracelet, wraps the newborn in warm blankets, and then gives the infant to the partner or mother when he or she is ready.

When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. The nurse concludes that:
A) The placenta has separated.
B) A cervical tear occurred during the birth.
C) The woman is beginning to hemorrhage.
D) Clots have formed in the upper uterine segment.

A) The placenta has separated.
Feedback: Placental separation is indicated by a firmly contracting uterus, a change in the uterus from a discoid to a globular ovoid shape, a sudden gush of dark red blood from the introitus, an apparent lengthening of the umbilical cord, and a finding of vaginal fullness. Cervical tears that do not extend to the vagina result in minimal blood loss. Signs of hemorrhage are a boggy uterus, bright red vaginal bleeding, alterations in vital signs, pallor, lightheadedness, restlessness, decreased urinary output, and alteration in the level of consciousness. If clots have formed in the upper uterine segment, the nurse would expect to find the uterus boggy and displaced to the side.

B) Stimulate uterine contraction.
Feedback: Oxytocics stimulate uterine contractions, which reduce blood loss after the third stage of labor. Oxytocics are not used to treat pain or prevent infection. They cause the uterus to contract, which reduces blood loss. Oxytocics do not facilitate rest and relaxation.

After an emergency birth, the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity is to:
A) Facilitate maternal-newborn interaction.
B) Stimulate the uterus to contract.
C) Prevent neonatal hypoglycemia.
D) Initiate the lactation cycle.

B) Stimulate the uterus to contract.
Feedback: Stimulation of the nipples through breastfeeding or manual stimulation causes the release of oxytocin and prevents maternal hemorrhage. Breastfeeding facilitates maternal-newborn interaction, but it is not the primary reason a woman is encouraged to breastfeed after an emergency birth. The primary intervention for preventing neonatal hypoglycemia is thermoregulation. Cold stress can result in hypoglycemia. The woman is encouraged to breastfeed after an emergency birth to stimulate the release of oxytocin, which prevents hemorrhage. Breastfeeding is encouraged to initiate the lactation cycle, but it is not the primary reason for this activity after an emergency birth. Stimulation of the nipples through breastfeeding or manual stimulation causes the release of oxytocin and prevents maternal hemorrhage.

A pregnant woman is in her third trimester. She asks the nurse to explain how she can tell true labor from false labor. The nurse would tell her that true labor contractions:
A) Increase with activity such as ambulation.
B) Decrease with activity.
C) Are always accompanied by the rupture of the bag of waters.
D) Alternate between a regular and irregular pattern.

A) Increase with activity such as ambulation.
Feedback: True labor contractions become more intense with walking. False labor contractions often stop with walking or position changes. Rupture of membranes may occur before or during labor. True labor contractions are regular.

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is:
A) “Don’t worry about it. You’ll do fine.”
B) “It’s normal to be anxious about labor. Let’s discuss what makes you afraid.”
C) “Labor is scary to think about, but the actual experience isn’t.”
D) “You can have an epidural. You won’t feel anything.”

B) “It’s normal to be anxious about labor. Let’s discuss what makes you afraid.”
Feedback: "It's normal to be anxious about labor. Let's discuss what makes you afraid" allows the woman to share her concerns with the nurse and is a therapeutic communication tool. "Don't worry about it. You'll do fine" negates the woman's fears and is not therapeutic. "Labor is scary to think about, but the actual experience isn't" negates the woman's fears and offers a false sense of security. It is not true that every woman may have an epidural. A number of criteria must be met for use of an epidural. Furthermore, many women still experience the feeling of pressure with an epidural.

An OB/GYN nurse is teaching a class on medications that affect uterine function. The nurse asks the class, "What is the purpose of tocolytic agents?" Which response by a member of the class indicates a correct understanding of the purpose of these drugs? "Tocolytics are used to
A) Augment labor.”
B) Control postpartum bleeding.”
C) Induce abortion.”
D) Suppress preterm labor.”

D) Suppress preterm labor.”
Feedback: Tocolytic agents are used to suppress preterm labor. Tocolytic agents are not used to induce labor, induce abortion, or control postpartum bleeding.

The nurse has just administered intravenous (IV) methylergonovine (Methergine) to a postpartum patient to prevent bleeding. Later in the shift, the patient begins to vomit and complains of nausea and a headache. The nurse initially should assess the patient's
A) Bleeding status.
B) Blood pressure.
C) Headache.
D) Renal function.

B) Blood pressure.
Feedback: The nurse should assess the patient's blood pressure first. Hypertension can be severe and may be associated with nausea, vomiting, headache, and convulsions. Death also is possible. Nothing indicates that the patient's bleeding status needs to be checked; the symptoms described are associated with hypervolemia. Migraine may occur with methylergonovine, but the initial assessment should be the blood pressure. Nothing indicates that the kidneys are being affected.

An obstetrical nurse is caring for a patient in preterm labor. The nurse implements an order for IV magnesium sulfate. Which clinical manifestations would indicate that the patient has received too much of the medication?
A) Temperature of 104.4° F
B) Paralytic ileus
C) Hypertension
D) Confusion

The nurse is monitoring a patient who is having her sixth child. The patient has gone beyond term, and labor is being induced with oxytocin (Pitocin). The nurse understands that this patient is at risk for
A) Hemorrhage.
B) Placental insufficiency.
C) Uterine rupture.
D) Water intoxication.

C) Uterine rupture.
Feedback: Induction of labor in women of high parity (five or more pregnancies) carries a high risk of uterine rupture, and oxytocin should be used with great caution. Oxytocin poses no apparent risk of hemorrhage or placental insufficiency. The patient would be at risk for water intoxication if high doses of oxytocin were being administered.

A) Contractions lasting longer than 60 seconds
Feedback: The nurse would discontinue the medication if contractions lasting longer than 60 seconds occurred, because this may indicate maternal and/or fetal distress. Contractions occurring every 2 to 3 minutes are considered normal. Complications that usually require interruption of the infusion include elevation of the resting uterine pressure above 15 to 20 mm Hg, so this response is considered normal. The fetal heart rate of 130 beats per minute is normal and this response also says the fetal heart rate is regular.

The nurse on a postpartum unit is reviewing the medication administration record of a patient receiving IV methylergonovine (Methergine). For which of the following patients would the nurse question the order?
A) The patient with diabetes
B) The patient with a urinary tract infection (UTI)
C) The patient with a migraine
D) The patient with hypertension

D) The patient with hypertension
Feedback: Hypertension can be severe and may be associated with nausea, vomiting, and headache; convulsions and death have occurred. Nothing indicates that diabetes or a UTI is a contraindication for use of this medication. Migraine is not a contraindication; however, methylergonovine may cause migraine because of its vasodilative effect.

During a postpartum assessment, a nurse discovers a boggy uterus and increased vaginal bleeding. The patient has been unable to tolerate oxytocin or carboprost tromethamine (Hemabate). The nurse anticipates the administration of which drug?
A) Prostaglandin E
B) Ergonovine (Ergotrate)
C) Terbutaline (Brethine)
D) Clomiphene (Clomid)

B) Ergonovine (Ergotrate)
Feedback: The nurse should anticipate the administration of ergonovine, which is indicated for vaginal bleeding. Ergonovine is indicated in patients who are unable to tolerate oxytocin or carboprost tromethamine. Neither prostaglandin E nor clomiphene is indicated in the treatment of vaginal bleeding. Terbutaline is not indicated in the treatment of vaginal bleeding.

Running by the nurses' station, the prescriber tells the nurse to prepare for IV administration of ergonovine (Ergotrate) stat. The nurse quickly gets the medication and enters the patient's room. What clinical manifestation would the nurse expect the patient to show?
A) Excessive bleeding
B) Water intoxication
C) Active labor
D) Hypertension

A) Excessive bleeding
Feedback: The clinical manifestation the nurse should expect to see is hemorrhage. Water intoxication is associated with oxytocin administration, but the scenario does not state that the patient was receiving oxytocin. Ergot alkaloids are not recommended for use during labor. Ergonovine actually can cause hypertension.

The nurse is creating a plan of care for a patient in labor. Which nursing diagnosis would have priority for a patient receiving intravenous oxytocin (Pitocin)?
A) Risk for impaired comfort
B) Risk for urinary retention
C) Risk for nutrition, more than body requirements
D) Risk for fluid volume excess

D) Risk for fluid volume excess
Feedback: The most appropriate nursing diagnosis, which would take priority, is risk for fluid volume excess. IV oxytocin causes water retention, and the patient should be monitored for water intoxication. Oxytocin poses no risk for urinary retention or impaired comfort. There is no apparent indication that the patient is at risk for excess nutrition.

A nurse is creating a plan of care for an obstetrical patient receiving tocolytic medications. The nurse provides patient education about the medication. The nurse asks the patient, "What outcome do we want to see as a result of the tocolytic therapy?" Which response by the patient best demonstrates understanding of this medication?
A) “I will have sufficient milk production.”
B) “The medication will directly affect my comfort level.”
C) “The delivery will be postponed at least 24 hours.”
D) “My breasts will be soft but not engorged.”

C) “The delivery will be postponed at least 24 hours.”
Feedback: Tocolytic therapy is implemented to suppress preterm labor. Tocolytic therapy does not affect milk production or the breasts. Tocolytic therapy may indirectly affect the patient's comfort level by reducing contractions, but it does not directly affect comfort level.

The nurse is caring for several patients on an OB unit and is preparing to pass medications. For which patients would the nurse question an order for dinoprostone (Prepidil, Cervidil)? (Select all that apply.)
A) The patient in need of cervical ripening
B) The patient with premature labor
C) The patient with pelvic inflammatory disease (PID)
D) The patient with a history of liver disease
E) The patient with a history of asthma

B) The patient with premature labor
C) The patient with pelvic inflammatory disease (PID)
D) The patient with a history of liver disease
E) The patient with a history of asthma
Feedback: Indications for the use of dinoprostone include a patient in need of cervical ripening prior to induction of labor. Dinoprostone is contraindicated in patients with PID, liver disease, and lung disease. It is not used in patients with premature labor.

A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this woman's fundus?
A) One centimeter above the umbilicus
B) Two centimeters below the umbilicus
C) Midway between the umbilicus and the symphysis pubis
D) Nonpalpable abdominally

A) One centimeter above the umbilicus
Feedback: Within 12 hours after delivery the fundus may be approximately 1 cm above the umbilicus. The fundus descends about 1 to 2 cm every 24 hours. Within 12 hours after delivery the fundus may be approximately 1 cm above the umbilicus. By the sixth postpartum week the fundus normally is halfway between the symphysis pubis and the umbilicus. The fundus should be easily palpated using the maternal umbilicus as a reference point.

Which woman is most likely to experience strong afterpains?
A) A woman who experienced oligohydramnios
B) A woman who is a gravida 4, para 4-0-0-4
C) A woman who is bottle-feeding her infant
D) A woman whose infant weighed 5 pounds, 3 ounces

B) A woman who is a gravida 4, para 4-0-0-4
Feedback: Afterpains are more common in multiparous women. Afterpains are more noticeable with births in which the uterus was greatly distended, as in a woman who experienced polyhydramnios or a woman who delivered a large infant. Breastfeeding may cause afterpains to intensify.

A woman gave birth to a healthy infant boy 5 days ago. What type of lochia would the nurse expect to find when assessing this woman?
A) Lochia rubra
B) Lochia sangra
C) Lochia alba
D) Lochia serosa

D) Lochia serosa
Feedback: Lochia serosa, which consists of blood, serum, leukocytes, and tissue debris, generally occurs around day 3 or 4 after childbirth. Lochia rubra consists of blood and decidual and trophoblastic debris. The flow generally lasts 3 to 4 days and pales, becoming pink or brown. There is no such term as lochia sangra. Lochia alba occurs in most women after day 10 and can continue up to 6 weeks after childbirth.

C) Prolactin
Feedback: Prolactin levels in the blood increase progressively throughout pregnancy. In women who breastfeed, prolactin levels remain elevated into the sixth week after birth. Estrogen and progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period. Human placental lactogen levels decrease dramatically after expulsion of the placenta.

Two days ago a woman gave birth to a full-term infant. Last night she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. One mechanism for the diaphoresis and diuresis that this woman is experiencing during the early postpartum period is:
A) Elevated temperature caused by postpartum infection.
B) Increased basal metabolic rate after giving birth.
C) Loss of increased blood volume associated with pregnancy.
D) Increased venous pressure in the lower extremities.

C) Loss of increased blood volume associated with pregnancy.
Feedback: Within 12 hours of birth women begin to lose the excess tissue fluid that has accumulated during pregnancy. One mechanism for reducing these retained fluids is the profuse diaphoresis that often occurs, especially at night, for the first 2 or 3 days after childbirth. Postpartal diuresis is another mechanism by which the body rids itself of excess fluid.
An elevated temperature would cause chills and may cause dehydration, not diaphoresis and diuresis. Diaphoresis and diuresis sometimes are referred to as reversal of the water metabolism of pregnancy, not as the basal metabolic rate. Postpartal diuresis may be caused by the removal of increased venous pressure in the lower extremities.

A woman gave birth to a 7-pound, 3-ounce infant boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is:
A) Urinary tract infection.
B) Excessive uterine bleeding.
C) A ruptured bladder.
D) Bladder wall atony.

B) Excessive uterine bleeding.
Feedback: Excessive bleeding can occur immediately after birth if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly. A urinary tract infection may result from overdistention of the bladder, but it is not the most serious consequence. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distention may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.

The nurse caring for the postpartum woman understands that breast engorgement is caused by:
A) Overproduction of colostrum.
B) Accumulation of milk in the lactiferous ducts.
C) Hyperplasia of mammary tissue.
D) Congestion of veins and lymphatics.

D) Congestion of veins and lymphatics.
Feedback: Breast engorgement is caused by the temporary congestion of veins and lymphatics , not by overproduction of colostrum, overproduction of milk, or hyperplasia of mammary tissue.

A) Temperature 37.9° C, heart rate 120, respirations 20, blood pressure (BP) 90/50.
Feedback: An EBL of 1500 ml with tachycardia and hypotension suggests hypovolemia caused by excessive blood loss. An increased respiratory rate of 36 may be secondary to pain from the birth. Temperature may increase to 38° C during the first 24 hours as a result of the dehydrating effects of labor. A BP of 140/90 is slightly elevated, which may be caused by the use of oxytocic medications.

What statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth?
A) “My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter.”
B) “My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.”
C) “I will not have a menstrual cycle for 6 months after childbirth.”
D) “My first menstrual cycle will be heavier than normal and then will be light for several months after.”

B) “My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.”
Feedback: "Because this is your second cesarean birth, you will recover faster" is an accurate statement and indicates her understanding of her expected menstrual activity. She can expect her first menstrual cycle to be heavier than normal (which occurs by 3 months after childbirth), and the volume of her subsequent cycles will return to prepregnant levels within three or four cycles.

The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state is called the:
A) Involutionary period because of what happens to the uterus.
B) Lochia period because of the nature of the vaginal discharge.
C) Mini-tri period because it lasts only 3 to 6 weeks.
D) Puerperium, or fourth trimester of pregnancy.

D) Puerperium, or fourth trimester of pregnancy.
Feedback: The puerperium, also called the fourth trimester or the postpartum period of pregnancy, lasts about 3 to 6 weeks. Involution marks the end of the puerperium, or the fourth trimester of pregnancy. Lochia refers to the various vaginal discharges during the puerperium, or fourth trimester of pregnancy.

A) Autolysis.
Feedback: Autolysis is caused by a decrease in hormone levels. Subinvolution is failure of the uterus to return to a nonpregnant state. Afterpain is caused by uterine cramps 2 to 3 days after birth. Diastasis refers to the separation of muscles.

With regard to the postpartum uterus, nurses should be aware that:
A) At the end of the third stage of labor it weighs approximately 500 g.
B) After 2 weeks postpartum it should not be palpable abdominally.
C) After 2 weeks postpartum it weighs 100 g.
D) It returns to its original (prepregnancy) size by 6 weeks, postpartum.

B) After 2 weeks postpartum it should not be palpable abdominally.
Feedback: After 2 weeks postpartum, the uterus should be be palpable abdominally; however, it does not return to its original size. At the end of the third stage of labor, the uterus weighs approximately 1000 g. It does not return to its original size. After 2 weeks postpartum the uterus weighs about 350 g; not its original size. The normal self-destruction of excess hypertrophied tissue accounts for the slight increase in uterine size after each pregnancy.

With regard to afterbirth pains, nurses should be aware that these pains are:
A) Caused by mild, continuous contractions for the duration of the postpartum period.
B) More common in first-time mothers.
C) More noticeable in births in which the uterus was overdistended.
D) Alleviated somewhat when the mother breastfeeds.

C) More noticeable in births in which the uterus was overdistended.
Feedback: A large baby or multiple babies overdistend the uterus. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations, which persist through the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

Postbirth uterine/vaginal discharge, called lochia:
A) Is similar to a light menstrual period for the first 6 to 12 hours.
B) Is usually greater after cesarean births.
C) Will usually decrease with ambulation and breastfeeding.
D) Should smell like normal menstrual flow unless an infection is present.

D) Should smell like normal menstrual flow unless an infection is present.
Feedback: An offensive odor usually indicates an infection. Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after cesarean births and usually increases with ambulation and breastfeeding.

Which description of postpartum restoration or healing times is accurate?
A) The cervix shortens, becomes firm, and returns to form within a month postpartum.
B) The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth.
C) Most episiotomies heal within a week.
D) Hemorrhoids usually decrease in size within 2 weeks of childbirth.

B) The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth.
Feedback: The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth; however, lubrication may take longer. The cervix regains its form within days; the cervical os may take longer. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.

With regard to postpartum ovarian function, nurses should be aware that:
A) Almost 75% of women who do not breastfeed resume menstruating within a month after birth.
B) Ovulation occurs slightly earlier for breastfeeding women.
C) Because of menstruation/ovulation schedules, contraception considerations can be postponed until after the puerperium.
D) The first menstrual flow after childbirth usually is heavier than normal.

D) The first menstrual flow after childbirth usually is heavier than normal.
Feedback: The first flow is heavier, but within three or four cycles, it is back to normal. Ovulation can occur within the first month, but for 70% of nonlactating women, it returns in about 3 months. Breastfeeding women take longer to resume ovulation. Because many women ovulate before their first postpartum menstrual period, contraceptive options need to be discussed early in the puerperium.

With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that:
A) Kidney function returns to normal a few days after birth.
B) Diastasis recti abdominis is a common condition that alters the voiding reflex.
C) Fluid loss through perspiration and increased urinary output accounts for a weight loss of over 2 kg during the puerperium.
D) With adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth.

C) Fluid loss through perspiration and increased urinary output accounts for a weight loss of over 2 kg during the puerperium.
Feedback: Excess fluid loss through other means occurs as well. Kidney function usually returns to normal in about a month. Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex. Bladder tone usually is restored 5 to 7 days after childbirth.

Knowing that the condition of the new mother's breasts will be affected by whether she is breastfeeding, nurses should be able to tell their clients all of the following statements except:
A) Breast tenderness is likely to persist for about a week after the start of lactation.
B) As lactation is established, a mass may form that can be distinguished from cancer by its position shift from day to day.
C) In nonlactating mothers colostrum is present for the first few days after childbirth.
D) If suckling is never begun (or is discontinued), lactation ceases within a few days to a week.

A) Breast tenderness is likely to persist for about a week after the start of lactation.
Feedback: Breast tenderness should persist only about 48 hours after lactation begins. That movable, noncancerous mass is a filled milk sac. Colostrum is present for a few days whether the mother breastfeeds or not. A mother who does not want to breastfeed should also avoid stimulating her nipples.

With regard to the postpartum changes and developments in a woman's cardiovascular system, nurses should be aware that:
A) Cardiac output, the pulse rate, and stroke volume all return to prepregnancy normal values within a few hours of childbirth.
B) Respiratory function returns to nonpregnant levels by 6 to 8 weeks after birth.
C) The lowered white blood cell count after pregnancy can lead to false-positive results on tests for infections.
D) A hypercoagulable state protects the new mother from thromboembolism, especially after a cesarean birth.

B) Respiratory function returns to nonpregnant levels by 6 to 8 weeks after birth.
Feedback: Respirations should decrease to within the woman's normal prepregnancy range by 6 to 8 weeks after birth. Stroke volume increases, and cardiac output remains high for a couple of days. However, the heart rate and blood pressure return to normal quickly. Leukocytosis increases 10 to 12 days after childbirth, which can obscure the diagnosis of acute infections (false-negative results). The hypercoagulable state increases the risk of thromboembolism, especially after a cesarean birth.

Which condition, not uncommon in pregnancy, is likely to require careful medical assessment during the puerperium?
A) Varicosities of the legs
B) Carpal tunnel syndrome
C) Periodic numbness and tingling of the fingers
D) Headaches

D) Headaches
Feedback: Headaches in the postpartum period can have a number of causes, some of which deserve medical attention. Total or nearly total regression of varicosities is expected after childbirth. However, headaches might deserve attention. Carpal tunnel syndrome is relieved in childbirth when the compression on the median nerve is lessened. However, headaches might deserve attention. Periodic numbness of the fingers usually disappears after birth unless carrying the baby aggravates the condition. However, headaches might deserve attention.

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is:
A) Uterine atony.
B) Uterine inversion.
C) Vaginal hematoma.
D) Vaginal laceration.

A) Uterine atony.
Feedback: Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. Uterine inversion may lead to hemorrhage, but it is not the most likely source of this client's bleeding. Furthermore, if the woman were experiencing a uterine inversion, it would be evidenced by the presence of a large, red, rounded mass protruding from the introitus. A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding. A vaginal laceration may cause hemorrhage, but it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus.

B) Perform fundal massage.
Feedback: The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Although establishing venous access may be a necessary intervention, the initial intervention would be fundal massage. The woman may need surgical intervention to treat her postpartum hemorrhage, but the initial nursing intervention would be to assess the uterus. After uterine massage the nurse may want to catheterize the client to eliminate any bladder distention that may be preventing the uterus from contracting properly.

A) Subinvolution of the placental site.
Feedback: Late PPH may be the result of subinvolution of the uterus, pelvic infection, or retained placental fragments. Late PPH is not typically a result of defective vascularity of the decidua, cervical lacerations, or coagulation disorders.

What woman is at greatest risk for early postpartum hemorrhage (PPH)?
A) A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress
B) A woman with severe preeclampsia on magnesium sulfate whose labor is being induced
C) A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor
D) A primigravida in spontaneous labor with preterm twins

B) A woman with severe preeclampsia on magnesium sulfate whose labor is being induced
Feedback: Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. Although many causes and risk factors are associated with PPH, the primiparous woman being prepared for an emergency c-section, the multiparous woman with 8-hour labor, and the primigravida in spontaneous labor do not pose risk factors or causes of early PPH.

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to:
A) Call the woman’s primary health care provider.
B) Administer the standing order for an oxytocic.
C) Palpate the uterus and massage it if it is boggy.
D) Assess maternal blood pressure and pulse for signs of hypovolemic shock.

C) Palpate the uterus and massage it if it is boggy.
Feedback: The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Though calling the health care provider, administering an oxytocic, and assessing maternal BP are appropriate interventions, the primary intervention should be to assess the uterus. Uterine atony is the leading cause of postpartum hemorrhage (PPH).

When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is:
A) Absence of cyanosis in the buccal mucosa.
B) Cool, dry skin.
C) Increased restlessness.
D) Urinary output of at least 30 ml/hr.

D) Urinary output of at least 30 ml/hr.
Feedback: Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion. The assessment of the buccal mucosa for cyanosis can be subjective in nature. The presence of cool, pale, clammy skin would be an indicative finding associated with hemorrhagic shock. Hemorrhagic shock is associated with lethargy, not restlessness.

One of the first symptoms of puerperal infection to assess in the postpartum woman is:
A) Fatigue continuing for longer than 1 week.
B) Pain with voiding.
C) Profuse vaginal bleeding with ambulation.
D) Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth.

D) Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth.
Feedback: Postpartum or puerperal infection is any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth. The definition used in the United States continues to be the presence of a fever of 38° C (100.4° F) or higher on 2 successive days of the first 10 postpartum days, starting 24 hours after birth. Fatigue would be a late finding associated with infection. Pain with voiding may indicate a urinary tract infection, but it is not typically one of the earlier symptoms of infection. Profuse lochia may be associated with endometritis, but it is not the first symptom associated with infection.

The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by:
A) Washing the nipples and breasts with mild soap and water once a day.
B) Using proper breastfeeding techniques.
C) Wearing a nipple shield for the first few days of breastfeeding.
D) Wearing a supportive bra 24 hours a day.

B) Using proper breastfeeding techniques.
Feedback: Almost all instances of acute mastitis can be avoided by proper breastfeeding technique to prevent cracked nipples. Washing the nipples and breasts daily is no longer indicated. In fact, this can cause tissue dryness and irritation, which can lead to tissue breakdown and infection. Wearing a nipple shield does not prevent mastitis. Wearing a supportive bra 24 hours a day may contribute to mastitis, especially if an underwire bra is worn, because it may put pressure on the upper, outer area of the breast, contributing to blocked ducts and mastitis.

Nurses need to know the basic definitions and incidence data about postpartum hemorrhage (PPH). For instance:
A) PPH is easy to recognize early; after all, the woman is bleeding.
B) Traditionally it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH.
C) If anything, nurses and doctors tend to overestimate the amount of blood loss.
D) Traditionally PPH has been classified as early or late with respect to birth.

D) Traditionally PPH has been classified as early or late with respect to birth.
Feedback: Early PPH is also known as primary, or acute, PPH; late PPH is known as secondary PPH. Unfortunately PPH can occur with little warning and often is recognized only after the mother has profound symptoms. Traditionally a 500-ml blood loss after a vaginal birth and a 1000-ml blood loss after a cesarean birth constitute PPH. Medical personnel tend to underestimate blood loss by as much as 50% in their subjective observations.

A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination the nurse notices warmth and redness over an enlarged, hardened area. The nurse should suspect __________ and should confirm the diagnosis by ___________.
A) Disseminated intravascular coagulation; asking for laboratory tests
B) von Willebrand disease; noting whether bleeding times have been extended
C) Thrombophlebitis; using real-time and color Doppler ultrasound
D) Coagulopathies; drawing blood for laboratory analysis

C) Thrombophlebitis; using real-time and color Doppler ultrasound
Feedback: Pain and tenderness in the extremities, which show warmth, redness, and hardness, likely indicate thrombophlebitis. A Doppler ultrasound is a common noninvasive way to confirm diagnosis.

What PPH conditions are considered medical emergencies that require immediate treatment?
A) Inversion of the uterus and hypovolemic shock
B) Hypotonic uterus and coagulopathies
C) Subinvolution of the uterus and idiopathic thrombocytopenic purpura
D) Uterine atony and disseminated intravascular coagulation

A) Inversion of the uterus and hypovolemic shock
Feedback: Inversion of the uterus and hypovolemic shock are considered medical emergencies. Although hypotonic uterus and coagulopathies, subinvolution of the uterus and idiopathic thrombocytopenic purpura, and uterine atony and disseminated intravascular coagulation are serious conditions, they are not necessarily medical emergencies that requires immediate treatment.

C) Mastitis
Feedback: Mastitis is infection in a breast, usually confined to a milk duct. Most women who suffer this are first-timers who are breastfeeding.

Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks after delivery as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is:
A) Cryoprecipitate.
B) Factor VIII and vWf.
C) Desmopressin.
D) Hemabate.

C) Desmopressin.
Feedback: Desmopressin is the primary treatment of choice. This hormone can be administered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage. Cryoprecipitate may be used; however, because of the risk of possible donor viruses, other modalities are considered safer. Treatment with plasma products such as factor VIII and vWf are an acceptable option for this client. Because of the repeated exposure to donor blood products and possible viruses, this is not the initial treatment of choice. Although the administration of this prostaglandin is known to promote contraction of the uterus during postpartum hemorrhage, it is not effective for the client who presents with a bleeding disorder.

The nurse should be aware that a pessary would be most effective in the treatment of what disorder?
A) Cystocele
B) Uterine prolapse
C) Rectocele
D) Stress urinary incontinence

B) Uterine prolapse
Feedback: A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position. A pessary is not used for a cystocele, a rectocele, or stress urinary incontinence.

A mother in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems and sensations of bearing down and of something in her vagina. The nurse would realize that the client most likely is suffering from:
A) Pelvic relaxation.
B) Cystoceles and/or rectoceles.
C) Uterine displacement.
D) Genital fistulas.

B) Cystoceles and/or rectoceles.
Feedback: Cystoceles are protrusions of the bladder downward into the vagina; rectoceles are herniations of the anterior rectal wall through a relaxed or ruptured vaginal fascia. Both can present as a bearing down sensation with urinary dysfunction. They occur more often in older women who have borne children.

The prevalence of urinary incontinence (UI) increases as women age, with more than one third of women in the United States suffering from some form of this disorder. The symptoms of mild-to-moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first?
A) Pelvic floor support devices
B) Bladder training and pelvic muscle exercises
C) Surgery
D) Medications

B) Bladder training and pelvic muscle exercises
Feedback: Pelvic muscle exercises, known as Kegel exercises, along with bladder training can significantly decrease or entirely relieve stress incontinence in many women. Pelvic floor support devices, also known as pessaries, come in a variety of shapes and sizes. Pessaries may not be effective for all women and require scrupulous cleaning to prevent infection. Anterior and posterior repairs and even a hysterectomy may be performed. If surgical repair is performed, the nurse must focus her care on preventing infection and helping the woman avoid putting stress on the surgical site. Pharmacologic therapy includes serotonin-norepinephrine uptake inhibitors or vaginal estrogen therapy. These are not the first action a nurse should recommend.

When a woman is diagnosed with postpartum depression (PPD) with psychotic features, one of the main concerns is that she may:
A) Have outbursts of anger.
B) Neglect her hygiene.
C) Harm her infant.
D) Lose interest in her husband.

C) Harm her infant.
Feedback: Thoughts of harm to one's self or the infant are among the most serious symptoms of PPD and require immediate assessment and intervention. Although outbursts of anger, hygiene neglect, and loss of interest in her husband are attributable to PPD, the major concern would be the potential to harm herself or her infant.

According to Beck's studies, what risk factor for postpartum depression is likely to have the greatest effect on the woman's condition?
A) Prenatal depression
B) Single-mother status
C) Low socioeconomic status
D) Unplanned or unwanted pregnancy

A) Prenatal depression
Feedback: Prenatal depression has been found by Beck to have the greatest likely effect. Single-mother status and low socioeconomic status are small-relation predictors, as is an unwanted pregnancy.

To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) without psychotic features:
A) Means that the woman is experiencing the baby blues. In addition she has a visit with a counselor or psychologist.
B) Is more common among older, Caucasian women because they have higher expectations.
C) Is distinguished by irritability, severe anxiety, and panic attacks.
D) Will disappear on its own without outside help.

C) Is distinguished by irritability, severe anxiety, and panic attacks.
Feedback: PPD is also characterized by spontaneous crying long after the usual duration of the baby blues. PPD, even without psychotic features, is more serious and persistent than postpartum baby blues. It is more common among younger mothers and African-American mothers. Most women need professional help to get through PPD, including pharmacologic intervention.

To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) with psychotic features:
A) Is more likely to occur in women with more than two children.
B) Is rarely delusional and then usually about someone trying to harm her (the mother).
C) Although serious, is not likely to need psychiatric hospitalization.
D) May include bipolar disorder (formerly called “manic depression”).

D) May include bipolar disorder (formerly called “manic depression”).
Feedback: Manic mood swings are possible. PPD is more likely to occur in first-time mothers. Delusions may be present in 50% of women with PPD, usually about something being wrong with the infant. PPD with psychosis is a psychiatric emergency that requires hospitalization.

A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the woman place the infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the:
A) Transition period.
B) First period of reactivity.
C) Organizational stage.
D) Second period of reactivity.

B) First period of reactivity.
Feedback: The first period of reactivity is the first phase of transition and lasts up to 30 minutes after birth. The infant is highly alert during this phase. The transition period is the phase between intrauterine and extrauterine existence. There is no such phase as the organizational stage. The second period of reactivity occurs roughly between 4 and 8 hours after birth, after a period of prolonged sleep.

Part of the health assessment of a newborn is observing the infant's breathing pattern. A full-term newborn's breathing pattern is predominantly:
A) Abdominal with synchronous chest movements.
B) Chest breathing with nasal flaring.
C) Diaphragmatic with chest retraction.
D) Deep with a regular rhythm.

A) Abdominal with synchronous chest movements.
Feedback: In normal infant respiration the chest and abdomen rise synchronously, and breaths are shallow and irregular. Breathing with nasal flaring is a sign of respiratory distress. Diaphragmatic breathing with chest retraction is a sign of respiratory distress. Infant breaths are not deep with a regular rhythm.

While assessing the newborn, the nurse should be aware that the average expected apical pulse range of a full-term, quiet, alert newborn is:
A) 80 to 100 beats/min.
B) 100 to 120 beats/min.
C) 120 to 160 beats/min.
D) 150 to 180 beats/min.

C) 120 to 160 beats/min.
Feedback: The average infant heart rate while awake is 120 to 160 beats/min. The newborn's heart rate may be about 85 to 100 beats/min while sleeping. The infant's heart rate typically is a bit higher when alert but quiet. A heart rate of 150 to 180 beats/min is typical when the infant cries.

A newborn is placed under a radiant heat warmer, and the nurse evaluates the infant's body temperature every hour. Maintaining the newborn's body temperature is important for preventing:
A) Respiratory depression.
B) Cold stress.
C) Tachycardia.
D) Vasoconstriction.

B) Cold stress.
Feedback: Loss of heat must be controlled to protect the infant from the metabolic and physiologic effects of cold stress, and that is the primary reason for placing a newborn under a radiant heat warmer. Cold stress results in an increased respiratory rate and vasoconstriction.

A new mother states that her infant must be cold because the baby's hands and feet are blue. The nurse explains that this is a common and temporary condition called:
A) Acrocyanosis.
B) Erythema neonatorum.
C) Harlequin color.
D) Vernix caseosa.

A) Acrocyanosis.
Feedback: Acrocyanosis, or the appearance of slightly cyanotic hands and feet, is caused by vasomotor instability, capillary stasis, and a high hemoglobin level. Acrocyanosis is normal and appears intermittently over the first 7 to 10 days. Erythema toxicum (also called erythema neonatorum) is a transient newborn rash that resembles flea bites. The harlequin sign is a benign, transient color change in newborns. Half of the body is pale, and the other half is ruddy or bluish red with a line of demarcation. Vernix caseosa is a cheeselike, whitish substance that serves as a protective covering.

The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is:
A) Closure of fetal shunts in the circulatory system.
B) Full function of the immune defense system at birth.
C) Maintenance of a stable temperature.
D) Initiation and maintenance of respirations.

D) Initiation and maintenance of respirations.
Feedback: The most critical adjustment of a newborn at birth is the establishment of respirations. The cardiovascular system changes markedly after birth as a result of fetal respiration, which reduces pulmonary vascular resistance to the pulmonary blood flow and initiates a chain of cardiac changes that support the cardiovascular system. The infant relies on passive immunity received from the mother for the first 3 months of life. After the establishment of respirations, heat regulation is critical to newborn survival.

The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. The nurse responds to the parents by telling them:
A) “Infants can see very little until about 3 months of age.”
B) “Infants can track their parent’s eyes and distinguish patterns; they prefer complex patterns.”
C) “The infant’s eyes must be protected. Infants enjoy looking at brightly colored stripes.”
D) “It’s important to shield the newborn’s eyes. Overhead lights help them see better.”

B) “Infants can track their parent’s eyes and distinguish patterns; they prefer complex patterns.”
Feedback: "Infants can track their parent's eyes and distinguish patterns; they prefer complex patterns" is an accurate statement. Development of the visual system continues for the first 6 months of life. Visual acuity is difficult to determine, but the clearest visual distance for the newborn appears to be 19 cm. Infants prefer to look at complex patterns, regardless of the color. Infants prefer low illumination and withdraw from bright light.

A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, "What is this black, sticky stuff in her diaper?" The nurse's best response is:
A) “That’s meconium, which is your baby’s first stool. It’s normal.”
B) “That’s transitional stool.”
C) “That means your baby is bleeding internally.”
D) “Oh, don’t worry about that. It’s okay.”

A) “That’s meconium, which is your baby’s first stool. It’s normal.”
Feedback: "That's meconium, which is your baby's first stool. It's normal" is an accurate statement and the most appropriate response. Transitional stool is greenish brown to yellowish brown and usually appears by the third day after initiation of feeding. "That means your baby is bleeding internally" is not accurate. "Oh, don't worry about that. It's okay" is not an appropriate statement. It is belittling to the father and does not educate him about the normal stool patterns of his daughter.

With regard to the respiratory development of the newborn, nurses should be aware that:
A) The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth.
B) Newborns must expel the fluid from the respiratory system within a few minutes of birth.
C) Newborns are instinctive mouth breathers.
D) Seesaw respirations are no cause for concern in the first hour after birth.

A) The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth.
Feedback: The first breath produces a cry. Newborns continue to expel fluid for the first hour of life. Newborns are natural nose breathers; they may not have the mouth-breathing response to nasal blockage for 3 weeks. Seesaw respirations instead of normal abdominal respirations are not normal and should be reported.

By knowing about variations in infants' blood count, nurses can explain to their clients that:
A) A somewhat lower than expected red blood cell count could be the result of delay in clamping the umbilical cord.
B) The early high white blood cell (WBC) count is normal at birth and should decrease rapidly.
C) Platelet counts are higher than in adults for a few months.
D) Even a modest vitamin K deficiency means a problem with the ability of the blood to clot properly.

B) The early high white blood cell (WBC) count is normal at birth and should decrease rapidly.
Feedback: The WBC count is high the first day of birth and then declines rapidly. Delayed clamping of the cord results in an increase in hemoglobin and the red blood cell count. The platelet count essentially is the same for newborns and adults. Clotting is sufficient to prevent hemorrhage unless the vitamin K deficiency is significant.

An infant boy was born just a few minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. The Apgar assessment is performed:
A) Only if the newborn is in obvious distress.
B) Once by the obstetrician, just after the birth.
C) At least twice, 1 minute and 5 minutes after birth.
D) Every 15 minutes during the newborn’s first hour after birth.

C) At least twice, 1 minute and 5 minutes after birth.
Feedback: Apgar scoring is performed at 1 minute and 5 minutes after birth. Scoring may continue at 5-minute intervals if the infant is in distress and requires resuscitation efforts.

A new father wants to know what medication was put into his infant's eyes and why it is needed. The nurse explains to the father that the purpose of the Ilotycin ophthalmic ointment is to:
A) Destroy an infectious exudate caused by Staphylococcus that could make the infant blind.
B) Prevent gonorrheal and chlamydial infection of the infant’s eyes potentially acquired from the birth canal.
C) Prevent potentially harmful exudate from invading the tear ducts of the infant’s eyes, leading to dry eyes.
D) Prevent the infant’s eyelids from sticking together and help the infant see.

B) Prevent gonorrheal and chlamydial infection of the infant’s eyes potentially acquired from the birth canal.
Feedback: The purpose of the Ilotycin ophthalmic ointment is to prevent gonorrheal and chlamydial infection of the infant's eyes potentially acquired from the birth canal. Prophylactic ophthalmic ointment is instilled in the eyes of all neonates to prevent gonorrheal or chlamydial infection. Prophylactic ophthalmic ointment is not instilled to prevent dry eyes. It is instilled to prevent gonorrheal or chlamydial infection. Prophylactic ophthalmic ointment has no bearing on vision other than to protect against infection that may lead to vision problems.

A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. Information given to the infant's parents should be based on the knowledge that petechiae:
A) Are benign if they disappear within 48 hours of birth.
B) Result from increased blood volume.
C) Should always be further investigated.
D) Usually occur with forceps delivery.

A) Are benign if they disappear within 48 hours of birth.
Feedback: Petechiae, or pinpoint hemorrhagic areas, acquired during birth may extend over the upper portion of the trunk and face. These lesions are benign if they disappear within 2 days of birth and no new lesions appear. Petechiae may result from decreased platelet formation. In this situation the presence of petechiae is most likely a soft-tissue injury resulting from the nuchal cord at birth. Unless they do not dissipate in 2 days, there is no reason to alarm the family. Petechiae usually occur with a breech presentation vaginal birth.

A newborn is jaundiced and receiving phototherapy via ultraviolet bank lights. An appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy by this method would be to:
A) Apply an oil-based lotion to the newborn’s skin to prevent dying and cracking.
B) Limit the newborn’s intake of milk to prevent nausea, vomiting, and diarrhea.
C) Place eye shields over the newborn’s closed eyes.
D) Change the newborn’s position every 4 hours.

C) Place eye shields over the newborn’s closed eyes.
Feedback: The infant's eyes must be protected by an opaque mask to prevent overexposure to the light. Eye shields should cover the eyes completely but not occlude the nares. Lotions and ointments should not be applied to the infant because they absorb heat, and this can cause burns. The lights increase insensible water loss, placing the infant at risk for fluid loss and dehydration. Therefore it is important that the infant be adequately hydrated. The infant should be turned every 2 hours to expose all body surfaces to the light.

Early this morning, an infant boy was circumcised using the PlastiBell method. The nurse tells the mother that she and the infant can be discharged after:
A) The bleeding stops completely.
B) Yellow exudate forms over the glans.
C) The PlastiBell rim falls off.
D) The infant voids.

D) The infant voids.
Feedback: The infant should be observed for urination after the circumcision. Bleeding is a common complication after circumcision. The nurse will check the penis for 12 hours after a circumcision to assess and provide appropriate interventions for prevention and treatment of bleeding. Yellow exudates cover the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process. The PlastiBell remains in place for about a week and falls off when healing has taken place.

A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home?
A) Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours.
B) Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs.
C) Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change.
D) Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

C) Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change.
Feedback: Cleansing the penis gently with water and putting petroleum jelly around the glans after each diaper change is appropriate when caring for an infant who has had a circumcision. With each diaper change, the penis should be washed off with warm water to remove any urine or feces. If bleeding occurs, the nurse should apply gentle pressure to the site of the bleeding with a sterile gauze square. Yellow exudates cover the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process. The exudates should not be removed.

At 1 minute after birth the nurse assesses the infant and notes: a heart rate of 80 beats/min, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. The nurse would calculate an Apgar score of:
A) 4.
B) 5.
C) 6.
D) 7.

B) 5.
Feedback: Each of the five signs the nurse noted would score a 1 on the Apgar scale, for a total of 5.

With regard to umbilical cord care, nurses should be aware that:
A) The stump can easily become infected.
B) A nurse noting bleeding from the vessels of the cord should immediately call for assistance.
C) The cord clamp is removed at cord separation.
D) The average cord separation time is 5 to 7 days.

A) The stump can easily become infected.
Feedback: The cord stump is an excellent medium for bacterial growth. The nurse should first check the clamp (or tie) and apply a second one. If the bleeding does not stop, the nurse calls for assistance. The cord clamp is removed after 24 hours when it is dry. The average cord separation time is 10 to 14 days.

During the complete physical examination 24 hours after birth:
A) The parents are excused to reduce their normal anxiety.
B) The nurse can gauge the neonate’s maturity level by assessing its general appearance.
C) Once often neglected, blood pressure is now routinely checked.
D) When the nurse listens to the heart, the S1 and S2 sounds can be heard; the first sound is somewhat higher in pitch and sharper than the second.

B) The nurse can gauge the neonate’s maturity level by assessing its general appearance.
Feedback: The nurse will be looking at skin color, alertness, cry, head size, and other features. The parents' presence actively involves them in child care and gives the nurse a chance to observe interactions. Blood pressure is not usually taken unless cardiac problems are suspected. The second sound is higher and sharper than the first.

Pain should be assessed regularly in all newborn infants. If the infant is displaying physiologic or behavioral cues indicating pain, measures should be taken to manage the pain. Examples of nonpharmacologic pain management techniques include (choose all that apply):
A) Swaddling.
B) Nonnutritive sucking.
C) Skin-to-skin contact with the mother.
D) Sucrose.
E) Acetaminophen.

A) Swaddling.
B) Nonnutritive sucking.
C) Skin-to-skin contact with the mother.
D) Sucrose.
Feedback: Swaddling, nonnutritive sucking, skin-to-skin contact with the mother, and sucrose are all appropriate nonpharmacologic techniques used to manage pain in neonates. Acetaminophen is a pharmacologic method of treating pain.

A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. The nurse can explain to him that beginning solid foods before 4 to 6 months may:
A) Decrease the infant’s intake of sufficient calories.
B) Lead to early cessation of breastfeeding.
C) Help the infant sleep through the night.
D) Limit the infant’s growth.

B) Lead to early cessation of breastfeeding.
Feedback: Introduction of solid foods before the infant is 4 to 6 months of age may result in overfeeding and decreased intake of breast milk. It is not true that feeding of solids helps infants sleep through the night. The proper balance of carbohydrate, protein, and fat for an infant to grow properly is in the breast milk or formula.

A pregnant woman wants to breastfeed her infant, but her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle-feeding. What statement is true? Bottle-feeding using commercially prepared infant formulas:
A) Increases the risk that the infant will develop allergies.
B) Helps the infant sleep through the night.
C) Ensures that the infant is getting iron in a form that is easily absorbed.
D) Requires that multivitamin supplements be given to the infant.

A) Increases the risk that the infant will develop allergies.
Feedback: Exposure to cow's milk poses a risk of developing allergies, eczema, and asthma.
This is a false statement. Iron is better absorbed from breast milk than from formula. Commercial formulas are designed to meet the nutritional needs of the infant and resemble breast milk.

A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. The nurse can facilitate the infant's correct latch-on by helping the woman hold the infant:
A) With his arms folded together over his chest.
B) Curled up in a fetal position.
C) With his head cupped in her hand.
D) With his head and body in alignment.

D) With his head and body in alignment.
Feedback: The infant's head and body should be in correct alignment with the mother and the breast during latch-on and feeding. Holding the infant with his arms folded together over his chest, curled up in a fetal position, or with his head cupped in her hand are not ideal positions to facilitate latch-on.

A new mother wants to be sure that she is meeting her daughter's needs while feeding her commercially prepared infant formula. The nurse should evaluate the mother's knowledge about appropriate infant care. The mother meets her child's needs when she:
A) Adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition.
B) Warms the bottles using a microwave oven.
C) Burps her infant during and after the feeding as needed.
D) Refrigerates any leftover formula for the next feeding.

C) Burps her infant during and after the feeding as needed.
Feedback: Most infants swallow air when fed from a bottle and should be given a chance to burp several times during a feeding and after the feeding. Solid food should not be introduced to the infant for at least 4 to 6 months after birth. A microwave should never be used to warm any food to be given to an infant. The heat is not distributed evenly, which may pose a risk of burning the infant. Any formula left in the bottle after the feeding should be discarded because the infant's saliva has mixed with it.

According to the recommendations of the American Academy of Pediatrics on infant nutrition:
A) Infants should be given only human milk for the first 6 months of life.
B) Infants fed on formula should be started on solid food sooner than breastfed infants.
C) If infants are weaned from breast milk before 12 months, they should receive cow’s milk, not formula.
D) After 6 months mothers should shift from breast milk to cow’s milk.

A) Infants should be given only human milk for the first 6 months of life.
Feedback: Breastfeeding/human milk should also be the sole source of milk for the second 6 months. Infants start on solids when they are ready, usually at 6 months, whether they start on formula or breast milk. If infants are weaned from breast milk before 12 months, they should receive iron-fortified formula, not cow's milk. Breastfeeding/human milk should also be the sole source of milk for the second 6 months.

What statement concerning the benefits or limitations of breastfeeding is NOT accurate?
A) Breast milk changes over time to meet changing needs as infants grow.
B) Long-term studies have shown that the benefits of breast milk continue after the infant is weaned.
C) Breast milk/breastfeeding may enhance cognitive development.
D) Breastfeeding increases the risk of childhood obesity.

D) Breastfeeding increases the risk of childhood obesity.
Feedback: Breastfeeding actually decreases the risk of childhood obesity. There are multiple benefits of breastfeeding. Breast milk changes over time to meet changing needs as infants grow. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. Breast milk/breastfeeding may enhance cognitive development.

A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization the infant is weighed, and the birth weight is 4550 g (9 pounds, 6 ounces). The nurse's most appropriate action is to:
A) Leave the infant in the room with the mother.
B) Take the infant immediately to the nursery.
C) Perform a gestational age assessment to determine whether the infant is large for gestational age.
D) Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia.

D) Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia.
Feedback: This infant is macrosomic (over 4000 g) and is at high risk for hypoglycemia. Blood glucose levels should be monitored frequently, and the infant should be observed closely for signs of hypoglycemia. Observation may occur in the nursery or in the mother's room, depending on the condition of the fetus. Regardless of gestational age, this infant is macrosomic.

An infant was born 2 hours ago at 37 weeks of gestation, weighing 4.1 kg. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of:
A) Birth injury.
B) Hypocalcemia.
C) Hypoglycemia.
D) Seizures.

C) Hypoglycemia.
Feedback: Hypoglycemia is common in the macrosomic infant. Signs of hypoglycemia include jitteriness, apnea, tachypnea, and cyanosis.

An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths/min with marked substernal retractions). The infant is given oxygen by continuous nasal positive airway pressure. Which arterial oxygen level would indicate hypoxia?
A) PaO2 of 67
B) PaO2 of 89
C) PaO2 of 45
D) PaO2 of 73

C) PaO2 of 45
Feedback: A PaO2 of 45 is below the normal range for a normal neonate. The normal range for arterial oxygen pressure is 60 to 70 mm Hg. The laboratory value of PaO2 of 45 indicates hypoxia in this infant.

An infant at 26 weeks of gestation arrives from the delivery room intubated. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. The nurse's most appropriate action would be to:
A) Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician.
B) Continue to observe and make no changes until the saturations are 75%.
C) Continue with the admission process to ensure that a thorough assessment is completed.
D) Notify the parents that their infant is not doing well.

A) Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician.
Feedback: Listening to breath sounds and ensuring the patency of the endotracheal tube, increasing oxygen, and notifying a physician appropriate nursing interventions to assist in optimal oxygen saturation of the infant. Oxygenation of the infant is crucial. O2 saturation should be maintained above 92%. Oxygenation status of the infant is crucial. The nurse should delay other tasks to stabilize the infant. Notifying the parents that the infant is not doing well is not an appropriate action. Further assessment and intervention are warranted before determination of fetal status.

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetrician's office revealed a nonreactive tracing. On artificial rupture of membranes, thick, meconium-stained fluid was noted. The nurse caring for the infant after birth should anticipate:
A) Meconium aspiration, hypoglycemia, and dry, cracked skin.
B) Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome.
C) Golden yellow- to green stained–skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat.
D) Hyperglycemia, hyperthermia, and an alert, wide-eyed appearance.

A) Meconium aspiration, hypoglycemia, and dry, cracked skin.
Feedback: Meconium aspiration, hypoglycemia, and dry, cracked skin are consistent with a postmature infant. Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome would be consistent with a very premature infant. The skin may be meconium stained, but the infant would most likely have longer hair and decreased amounts of subcutaneous fat. Postmaturity with a nonreactive NST would indicate hypoxia. Signs and symptoms associated with fetal hypoxia are hypoglycemia, temperature instability, and lethargy.

For clinical purposes preterm and postterm infants are defined as:
A) Preterm before 34 weeks if appropriate for gestational age (AGA); before 37 weeks if small for gestational age (SGA).
B) Postterm after 40 weeks if large for gestational age (LGA); beyond 42 weeks if AGA.
C) Preterm before 37 weeks, postterm beyond 42 weeks, no matter the size for gestational age at birth.
D) Preterm, SGA before 38 to 40 weeks; postterm, LGA beyond 40 to 42 weeks.

C) Preterm before 37 weeks, postterm beyond 42 weeks, no matter the size for gestational age at birth.
Feedback: Preterm and postterm are strictly measures of time—before 37 weeks and beyond 42 weeks respectively—regardless of size for gestational age.

With regard to small for gestational age (SGA) infants and intrauterine growth restrictions (IUGR), nurses should be aware that:
A) In the first trimester diseases or abnormalities result in asymmetric IUGR.
B) Infants with asymmetric IUGR have the potential for normal growth and development.
C) In asymmetric IUGR weight will be slightly more than SGA, whereas length and head circumference will be somewhat less than SGA.
D) Symmetric IUGR occurs in the later stages of pregnancy.

B) Infants with asymmetric IUGR have the potential for normal growth and development.
Feedback: IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester; SGA infants have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development.

A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth is 180 beats/min with limited variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. On the basis of the maternal history, the cause of this newborn's distress is most likely to be:
A) Hypoglycemia.
B) Phrenic nerve injury.
C) Respiratory distress syndrome.
D) Sepsis.

D) Sepsis.
Feedback: The prolonged rupture of membranes and the tachypnea (before and after birth) both suggest sepsis. An FHR of 180 beats/min is also indicative. This infant is at high risk for sepsis.

A) Good handwashing.Feedback: Virtually all controlled clinical trials have demonstrated that effective handwashing is responsible for the prevention of nosocomial infection in nursery units. Measures to be taken include Standard Precautions, careful and thorough cleaning, frequent replacement of used equipment, and disposal of excrement and linens in an appropriate manner. Overcrowding must be avoided in nurseries. However, the most important nursing action for preventing neonatal infection is effective handwashing.

A pregnant woman presents in labor at term, having had no prenatal care. After birth her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. On the basis of her infant's physical findings, this woman should be questioned about her use of which substance during pregnancy?
A) Alcohol
B) Cocaine
C) Heroin
D) Marijuana

A) Alcohol
Feedback: The description of the infant suggests fetal alcohol syndrome, which is consistent with maternal alcohol consumption during pregnancy. Fetal brain, kidney, and urogenital system malformations have been associated with maternal cocaine ingestions. Heroin use in pregnancy frequently results in intrauterine growth restriction. The infant may have a shrill cry and sleep cycle disturbances and present with poor feeding, tachypnea, vomiting, diarrhea, hypothermia or hyperthermia, and sweating. Studies have found a higher incidence of meconium staining in infants born of mothers who used marijuana during pregnancy.

During a prenatal examination, the woman reports having two cats at home. The nurse informs her that she should not be cleaning the litter box while she is pregnant. When the woman asks why, the nurse's best response would be:
A) “Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child.”
B) “You and your baby can be exposed to the human immunodeficiency virus (HIV) in your cats’ feces.”
C) “It’s just gross. You should make your husband clean the litter boxes.”
D) “Cat feces are known to carry Escherichia coli, which can cause a severe infection in both you and your baby.”

A) “Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child.”
Feedback: Toxoplasmosis is a multisystem disease caused by the protozoal Toxoplasma gondii parasite, commonly found in cats, dogs, pigs, sheep, and cattle. About 30% of women who contract toxoplasmosis during gestation transmit the disease to their offspring. Clinical features ascribed to toxoplasmosis include hydrocephalus or microcephaly, chorioretinitis, seizures, or cerebral calcifications. HIV is not transmitted by cats. Although suggesting that the woman's husband clean the litter boxes may be a valid statement, it is not appropriate, does not answer the client's question, and is not the nurse's best response. E. coli is found in normal human fecal flora. It is not transmitted by cats.

Near the end of the first week of life an infant who has not been treated for any infection develops a copper-colored, maculopapular rash on the palms and around the mouth and anus. The newborn is showing signs of:
A) Gonorrhea.
B) Herpes simplex virus infection.
C) Congenital syphilis.
D) Human immunodeficiency virus.

C) Congenital syphilis.
Feedback: The rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities.

D) Group B streptococcal infection
Feedback: Penicillin has significantly decreased the incidence of group B streptococcal infection. E. coli may be increasing, perhaps because of the increasing use of ampicillin (resulting in a more virulent E. coli resistant to the drug). Tuberculosis is increasing in the United States and Canada. Candidiasis is a fairly benign fungal infection.

In caring for the mother who has abused (or is abusing) alcohol and for her infant, nurses should be aware that:
A) The pattern of growth restriction of the fetus begun in prenatal life is halted after birth, and normal growth takes over.
B) Two thirds of newborns with fetal alcohol syndrome (FAS) are boys.
C) Alcohol-related neurodevelopmental disorders not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school.
D) Both the distinctive facial features of the FAS infant and the diminished mental capacities tend toward normal over time.

C) Alcohol-related neurodevelopmental disorders not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school.
Feedback: Some learning problems do not become evident until the child is at school. The pattern of growth restriction persists after birth. Two thirds of newborns with FAS are girls. Although the distinctive facial features of the FAS infant tend to become less evident, the mental capacities never become normal.

While completing a newborn assessment, the nurse should be aware that the most common birth injury is:
A) To the soft tissues.
B) Caused by forceps gripping the head on delivery.
C) Fracture of the humerus and femur.
D) Fracture of the clavicle.

D) Fracture of the clavicle.
Feedback: The most common birth injury is fracture of the clavicle (collarbone). It usually heals without treatment, although the arm and shoulder may be immobilized for comfort.

B) Hemolytic disorders in the newborn.Feedback: Hemolytic disorders in the newborn are the most common cause of pathologic jaundice. Hepatic damage may be a cause of pathologic hyperbilirubinemia, but it is not the most common cause. Prematurity would be a potential cause of pathologic hyperbilirubinemia in neonates, but it is not the most common cause. Congenital heart defect is not a common cause of pathologic hyperbilirubinemia in neonates.